Provider Demographics
NPI:1093082331
Name:MANTZ, PAUL S (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
Last Name:MANTZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-0270
Mailing Address - Country:US
Mailing Address - Phone:715-526-3314
Mailing Address - Fax:
Practice Address - Street 1:152 WOODLAWN DR
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-2200
Practice Address - Country:US
Practice Address - Phone:715-526-3314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6814-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1144684002Other1144684002
WI1144684002Medicaid