Individual
MARY T MANCUSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
27-11 PELLACK DR, FAIR LAWN, NJ 07410-3723
(201) 796-7171
(201) 796-0600
Mailing address
167 GLENWOOD DR, NORTH HALEDON, NJ 07508-3020
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
17835
NJ
Other
Enumeration date
09/14/2006
Last updated
07/08/2007
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