# COMPREHENSIVE & COSMETIC & GENERAL DISTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104930668
- **Authorized official:** ANTHONY JOSEPH MANCINO DDS (OWNER,PRESIDENT)
- **Authorized official phone:** (732) 556-9600

## Contact information

- **Practice address:** 3350 STATE ROUTE 138, STE 127, WALL TOWNSHIP, NJ 07719-9693
- **Practice address phone:** (732) 556-9600
- **Practice address fax:** (732) 556-9601
- **Mailing address:** 3350 STATE ROUTE 138, STE 127, WALL TOWNSHIP, NJ 07719-9693
- **Mailing address phone:** (732) 556-9600
- **Mailing address fax:** (732) 556-9601

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 11320 | NJ | Yes |

## Other

- **Enumeration date:** 08/19/2006
- **Last updated:** 05/06/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 11320 | INS CO'S | NJ |
| 01 | — | 90730-00-4 | NJ EMPLOYER ID | NJ |