Individual
DANA LEE MANCHESTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
205 N H ST, LOMPOC, CA 93436-6026
(805) 735-3611
(805) 737-1723
Mailing address
205 N H ST, LOMPOC, CA 93436-6026
(805) 735-3611
(805) 737-1723
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
26679
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27014240
STATE TAX ID
CA
01
—
953290069
FEDERAL TAX ID
CA
Enumeration date
04/02/2007
Last updated
07/08/2007
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