Individual
DR. JOHN MANTINAOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
5203 BROADWAY ST, QUINCY, IL 62305-9110
(217) 577-2400
(217) 228-1032
Mailing address
5203 BROADWAY ST, QUINCY, IL 62305-9110
(217) 577-2400
(217) 228-1032
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019028483
IL
122300000X
Dentist
048817-1
NY
122300000X
Dentist
12011569A
IN
122300000X
Dentist
22DI02373800
NJ
122300000X
Dentist
DN20160
MA
122300000X
Dentist
DS036424
PA
Other
Enumeration date
09/15/2008
Last updated
10/23/2014
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