Individual
DR. KEITH W MANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
818-101 PINE GROVE DRIVE, WILMINGTON, NC 28409
(910) 397-9277
(910) 397-9137
Mailing address
818-101 PINE GROVE DRIVE, WILMINGTON, NC 28409
(910) 397-9277
(910) 397-9137
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6156
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
523057
UNITED CONCORDIA
NC
05
—
8995504
—
NC
01
—
95504
BLUE CROSS BLUE SHIELD
NC
Enumeration date
03/09/2007
Last updated
07/08/2007
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