Organization
AMANA DENTAL CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAZEN MANLA DDS (PRESEDENT)
(312) 451-4050
Entity
Organization
Contact information
Practice address
2326 CENTRAL AVE NE, MINNEAPOLIS, MN 55418-3710
(612) 789-2928
(612) 789-2783
Mailing address
2326 CENTRAL AVE NE, MINNEAPOLIS, MN 55418-3710
(612) 789-2928
(612) 789-2783
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D 11855
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
330405100
—
MN
Enumeration date
01/08/2009
Last updated
01/08/2009
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