Provider Demographics
NPI:1346359031
Name:MANSOUR, RAYMOND NASAR (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:NASAR
Last Name:MANSOUR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 E LEXINGTON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-4520
Mailing Address - Country:US
Mailing Address - Phone:619-444-2191
Mailing Address - Fax:619-444-3531
Practice Address - Street 1:343 E LEXINGTON AVE STE 102
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4520
Practice Address - Country:US
Practice Address - Phone:619-444-2191
Practice Address - Fax:619-444-3531
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49045122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist