Individual
DEWEY WILSON MANN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
104 GOFF MTN RD, CROSS LANES, WV 25313
(304) 776-6992
(304) 776-6992
Mailing address
104 GOFF MTN RD, CROSS LANES, WV 25313
(304) 776-6992
(304) 776-6992
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2369
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0135558000
—
WV
Enumeration date
09/22/2006
Last updated
07/08/2007
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