MEDICARE: DR. MARY P MANI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS019118L	PA
2	1223P0300X	Periodontics	DS019118L	PA

General Provider Information

NPI Number	:	1396934642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY P MANI DDS

Provider Business Mailing Address
First Line	:	2128 CARRIAGE HILL RD
Second Line	:
City	:	ALLISON PARK
State	:	PA
Zip	:	15101-3322
Country	:	US
Telephone Number	:	412-367-4915
Fax Number	:

Provider Business Practice Location Address
First Line	:	2128 CARRIAGE HILL RD
Second Line	:
City	:	ALLISON PARK
State	:	PA
Zip	:	15101-3322
Country	:	US
Telephone Number	:	412-367-4915
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	10/22/2007

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