NPIMap

Organization Active NPI

Mannem & Associates, Inc

Doing business as Lakeway Periodontics

  • Periodontics
  • Lakeway, TX
National Provider Identifier
1083940340
Registry record updated Oct 21, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
19578 Issued in TX
Legal business name
MANNEM & ASSOCIATES, INC
Doing business as
Lakeway Periodontics
Practice address
3315 RR 620 S
Suite 250
Lakeway, TX 78738-6867
Phone
(512) 402-9090
NPI assigned
Oct 21, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sasi K Mannem, DDS
Title
Owner
Phone
(512) 402-9090

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0300X 19578 TX Primary

Addresses

Primary practice location

3315 RR 620 S
Suite 250
Lakeway, TX 78738-6867

Mailing address

3315 RR 620 S
Suite 250
Lakeway, TX 78738-6867
Phone (512) 402-9090

Other names 1

  • Lakeway Periodontics Doing business as

National Provider Directory

National Provider Directory

Locations

3315 Ranch Road 620 S
Ste 250
Lakeway, TX 78738
Phone (512) 402-9090

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1256083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256083200000",
    "number": "1083940340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3315 RR 620 S",
            "address_2": "SUITE 250",
            "city": "LAKEWAY",
            "state": "TX",
            "postal_code": "787386867",
            "telephone_number": "512-402-9090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3315 RR 620 S",
            "address_2": "SUITE 250",
            "city": "LAKEWAY",
            "state": "TX",
            "postal_code": "787386867",
            "telephone_number": "512-402-9090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANNEM & ASSOCIATES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-21",
        "last_updated": "2009-10-21",
        "status": "A",
        "authorized_official_last_name": "MANNEM",
        "authorized_official_first_name": "SASI",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "512-402-9090",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "TX",
            "license": "19578",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeway Periodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakeway, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.