Provider Demographics
NPI:1447689898
Name:CHARLES ASHLEY MANN DDS PA 2
Entity type:Organization
Organization Name:CHARLES ASHLEY MANN DDS PA 2
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LABRUYERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-838-7388
Mailing Address - Street 1:1310 FIFTH AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529
Mailing Address - Country:US
Mailing Address - Phone:919-838-7388
Mailing Address - Fax:919-443-1484
Practice Address - Street 1:1310 FIFTH AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529
Practice Address - Country:US
Practice Address - Phone:919-838-7388
Practice Address - Fax:919-443-1484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7007122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty