Provider Demographics
NPI:1356567614
Name:MANNING, CHRIS W III (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:W
Last Name:MANNING
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1194 PACIFIC ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3305
Mailing Address - Country:US
Mailing Address - Phone:805-544-4353
Mailing Address - Fax:
Practice Address - Street 1:1194 PACIFIC ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3305
Practice Address - Country:US
Practice Address - Phone:805-544-4353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41646122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA770379551OtherTIN