Provider Demographics
NPI:1548361223
Name:MANNINO, THOMAS CHRISTOPHER (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CHRISTOPHER
Last Name:MANNINO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25575 RUTLEDGE XING
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-1356
Mailing Address - Country:US
Mailing Address - Phone:248-477-3308
Mailing Address - Fax:248-324-1025
Practice Address - Street 1:27600 FARMINGTON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3348
Practice Address - Country:US
Practice Address - Phone:248-324-0075
Practice Address - Fax:248-324-1025
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI144341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice