Organization
COMPREHENSIVE & COSMETIC & GENERAL DISTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY JOSEPH MANCINO DDS (OWNER,PRESIDENT)
(732) 556-9600
Entity
Organization
Contact information
Practice address
3350 STATE ROUTE 138, STE 127, WALL TOWNSHIP, NJ 07719-9693
(732) 556-9600
(732) 556-9601
Mailing address
3350 STATE ROUTE 138, STE 127, WALL TOWNSHIP, NJ 07719-9693
(732) 556-9600
(732) 556-9601
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
11320
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11320
INS CO'S
NJ
01
—
90730-00-4
NJ EMPLOYER ID
NJ
Enumeration date
08/19/2006
Last updated
05/06/2015
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