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General NPI Number Information
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NPI Number | 1336305408
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Entity Type | Organization
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Legal Business Name | MARTINSVILLE PEDIATRIC DENTISTRY, LLC
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Dates
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Enumeration Date | 07/29/2008
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 1690 S OHIO ST
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City | MARTINSVILLE
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State | IN
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Zip | 46151-3317
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Country | US
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Telephone | 765-342-8435
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Fax |
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Provider Business Mailing Address
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Address Line | 1690 S OHIO ST
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City | MARTINSVILLE
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State | IN
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Zip | 46151-3317
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Country | US
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Telephone | 765-342-8435
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRETT E. MANN
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Credential | DDS, PC
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Telephone | 765-342-8435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 12009166
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License Number State | IN
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