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General NPI Number Information
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NPI Number | 1265872865
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Entity Type | Organization
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Legal Business Name | MANKE FAMILY DENTISTRY
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Dates
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Enumeration Date | 06/27/2013
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Last Update Date | 06/27/2013
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Provider Practice Location Address
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Address Line | 2401 S WASHINGTON ST SUITE B
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City | GRAND FORKS
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State | ND
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Zip | 58201-6747
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Country | US
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Telephone | 701-772-8158
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Fax | 701-772-9108
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Provider Business Mailing Address
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Address Line | 2401 S WASHINGTON ST SUITE B
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City | GRAND FORKS
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State | ND
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Zip | 58201-6747
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Country | US
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Telephone | 701-772-8158
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Fax | 701-772-9108
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RORY BRET MANKE
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Credential | D.D.S.
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Telephone | 701-772-8158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2174
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License Number State | ND
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