Individual provider Active NPI

Robert Manning, D.M.D.

  • General Practice Dentistry
  • Winona, MS
National Provider Identifier
1154447514
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
287995 Issued in MS
Practice address
1612 Hwy 51 N
Winona, MS 38967
Phone
(662) 283-4525
NPI assigned
Mar 21, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 287995 MS Primary

Addresses

Primary practice location

1612 Hwy 51 N
Winona, MS 38967

Mailing address

PO Box 69
1612 Hwy 51 N
Winona, MS 38967-0069
Phone (662) 283-4525

Other identifiers 1

IdentifierTypeStateIssuer
287995OtherMSLICENCE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150709002607 MS Order and Referring Only - Other (Physician)Practitioner - Other (Physician) 3375855919

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
287995MSMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1154447514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 69",
            "address_2": "1612 HWY 51 N",
            "city": "WINONA",
            "state": "MS",
            "postal_code": "389670069",
            "telephone_number": "662-283-4525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1612 HWY 51 N",
            "city": "WINONA",
            "state": "MS",
            "postal_code": "38967",
            "telephone_number": "662-283-4525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANNING",
        "first_name": "ROBERT",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "287995",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENCE NUMBER",
            "identifier": "287995",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winona, MS

Sources for this page

Verify at the official NPI Registry.