Provider Demographics
NPI:1649326828
Name:MANNING, KELLY EATON (RDH)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:EATON
Last Name:MANNING
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10737 WOODLORE PL
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-5401
Mailing Address - Country:US
Mailing Address - Phone:702-314-8670
Mailing Address - Fax:
Practice Address - Street 1:7520 W WASHINGTON AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-4330
Practice Address - Country:US
Practice Address - Phone:702-363-1590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101165124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist