Provider Demographics
NPI:1902468176
Name:MANNING, EDEN NETHERCUTT (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDEN
Middle Name:NETHERCUTT
Last Name:MANNING
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 PARRISH DR
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27863-9300
Mailing Address - Country:US
Mailing Address - Phone:919-734-2655
Mailing Address - Fax:
Practice Address - Street 1:104C ADAIR DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-4516
Practice Address - Country:US
Practice Address - Phone:919-648-4437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11524122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist