Provider Demographics
NPI:1871139923
Name:AMYRADAKIS MANN AND ASSOCIATES, DDS PA
Entity type:Organization
Organization Name:AMYRADAKIS MANN AND ASSOCIATES, DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-342-4555
Mailing Address - Street 1:280 BRAMBLEHILL DR
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-2377
Mailing Address - Country:US
Mailing Address - Phone:919-552-1044
Mailing Address - Fax:919-552-3790
Practice Address - Street 1:280 BRAMBLEHILL DR
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2377
Practice Address - Country:US
Practice Address - Phone:919-552-1044
Practice Address - Fax:919-552-3790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental