Provider Demographics
NPI:1134232408
Name:MANOWITZ, GARY E (DMD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:E
Last Name:MANOWITZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 MEETING HOUSE LN
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-5087
Mailing Address - Country:US
Mailing Address - Phone:631-283-0352
Mailing Address - Fax:631-283-0382
Practice Address - Street 1:325 MEETING HOUSE LN
Practice Address - Street 2:BUILDING 2
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-5087
Practice Address - Country:US
Practice Address - Phone:631-283-0352
Practice Address - Fax:631-283-0382
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042838122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist