MEDICARE: DR. T. BRETT MANN D.D.S.

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	12008751	IN

General Provider Information

NPI Number	:	1427004597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. T. BRETT MANN D.D.S.

Provider Business Mailing Address
First Line	:	616 S RANDOLPH ST
Second Line	:
City	:	GARRETT
State	:	IN
Zip	:	46738-1458
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	616 S RANDOLPH ST
Second Line	:
City	:	GARRETT
State	:	IN
Zip	:	46738-1458
Country	:	US
Telephone Number	:	260-357-3454
Fax Number	:	260-357-3177

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	07/08/2007

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