Individual
DR. VICTOR R MANCUSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
Contact information
Practice address
6400 SE LAKE RD STE 140, PORTLAND, OR 97222-2194
(503) 496-4766
(503) 496-4700
Mailing address
6400 SE LAKE RD STE 140, PORTLAND, OR 97222-2194
(503) 496-4766
(503) 496-4700
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
37698
CA
1223E0200X
Endodontics
Primary
D10405
OR
Other
Enumeration date
09/26/2006
Last updated
04/14/2021
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