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General NPI Number Information
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NPI Number | 1083940340
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Entity Type | Organization
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Legal Business Name | MANNEM & ASSOCIATES, INC
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Dates
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Enumeration Date | 10/21/2009
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Last Update Date | 10/21/2009
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Provider Practice Location Address
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Address Line | 3315 RR 620 S SUITE 250
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City | LAKEWAY
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State | TX
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Zip | 78738-6867
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Country | US
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Telephone | 512-402-9090
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Fax |
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Provider Business Mailing Address
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Address Line | 3315 RR 620 S SUITE 250
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City | LAKEWAY
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State | TX
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Zip | 78738-6867
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Country | US
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Telephone | 512-402-9090
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SASI K MANNEM
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Credential | DDS
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Telephone | 512-402-9090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 19578
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License Number State | TX
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