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General NPI Number Information
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NPI Number | 1568605731
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Entity Type | Individual
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Provider Name | PHILIP C MANN DDS, MD
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Gender | Male
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Dates
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Enumeration Date | 04/16/2009
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 16455 BOONES FERRY RD STE B
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-4367
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Country | US
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Telephone | 503-482-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 16455 BOONES FERRY RD STE B
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-4367
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Country | US
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Telephone | 503-482-7200
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Fax | 503-482-7221
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D9277
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | MD173704
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License Number State | OR
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