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General NPI Number Information
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NPI Number | 1720218985
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Entity Type | Organization
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Legal Business Name | ROBERT J. MANN
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Dates
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Enumeration Date | 07/22/2009
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Last Update Date | 07/22/2009
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Provider Practice Location Address
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Address Line | 115 MAIN ST E
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City | WABASHA
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State | MN
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Zip | 55981-1420
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Country | US
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Telephone | 651-565-3511
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Fax | 651-565-2224
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Provider Business Mailing Address
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Address Line | 115 MAIN ST E
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City | WABASHA
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State | MN
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Zip | 55981-1420
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Country | US
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Telephone | 651-565-3511
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Fax | 651-565-2224
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ROBERT JAMES MANN
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Credential | DDS
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Telephone | 651-565-3511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D12718
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8266
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License Number State | MN
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