Healthcare Provider Details

I. General information

NPI: 1609652635
Provider Name (Legal Business Name): DR.MANN FAMILY DENTAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 CHERRY LN
ROBERTS WI
54023-9731
US

IV. Provider business mailing address

507 CHERRY LN
ROBERTS WI
54023-9707
US

V. Phone/Fax

Practice location:
  • Phone: 262-836-4225
  • Fax: 715-600-9025
Mailing address:
  • Phone: 715-760-3700
  • Fax: 715-760-6191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AJAYPAL MANN
Title or Position: DENTIST
Credential: DMD
Phone: 715-760-3700