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General NPI Number Information
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NPI Number | 1306140652
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Entity Type | Organization
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Legal Business Name | MANKE FAMILY DENTISTRY, PC
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Dates
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Enumeration Date | 12/30/2010
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Last Update Date | 12/30/2010
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Provider Practice Location Address
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Address Line | 825 E 8TH ST SUITE 203
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City | WINNER
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State | SD
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Zip | 57580-2634
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Country | US
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Telephone | 605-842-2101
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Fax | 605-842-0493
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Provider Business Mailing Address
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Address Line | 825 E 8TH ST SUITE 203
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City | WINNER
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State | SD
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Zip | 57580-2634
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Country | US
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Telephone | 605-842-2101
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Fax | 605-842-0493
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DR. WILLIAM CHARLES MANKE
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Credential | D.D.S.
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Telephone | 605-842-2101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | M989
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License Number State | SD
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