Individual
DR. NICHOLAS E MANCUSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
18726 S NOGALES HWY STE 100, GREEN VALLEY, AZ 85614-5944
(520) 625-4850
Mailing address
18726 S NOGALES HWY STE 100, GREEN VALLEY, AZ 85614-5944
(520) 625-4850
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D011121
AZ
Other
Enumeration date
07/26/2021
Last updated
07/26/2021
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