John E. Manne, DDS
Individual provider Active NPI General Practice Dentistry · Tupper Lake, NY
NPI 1891701090 · NPPES record last updated Jun 14, 2018
Key facts
- NPI
- 1891701090
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 28270 (NY)
- Practice address
- 3 Main St
Tupper Lake, NY 12986 - Phone
- (518) 359-7353
- NPI assigned
- Jul 31, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28270 | NY | MD | General Practice Dentistry |
| 028270 | NY | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 28270 | NY | Yes |
Addresses
Primary practice location
3 Main St
Tupper Lake, NY 12986
Mailing address
3 Main St
Tupper Lake, NY 12986-1308
Phone (518) 359-7353
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01430313 | Medicaid | NY |
Other providers in Tupper Lake, NY
- Katherine L Lavery
- Jocelyn Marie Law
- Babette Michelle Leblanc
- Abigail C Lynch
- Stella Mallon
- Sylvia Rose Mattice
- Klaus Eric Meissner
- Lisa Meissner
- Carol Jane Merrihew
- Arthur V Morey
All providers in Tupper Lake, NY · General Practice Dentistry in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 14, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.