Provider Demographics
NPI:1467675660
Name:MANCINI, BERNARD VICTOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:VICTOR
Last Name:MANCINI
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 1:1308 CRESCENT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2702
Mailing Address - Country:US
Mailing Address - Phone:940-566-3368
Mailing Address - Fax:940-382-1066
Practice Address - Street 1:1308 CRESCENT ST
Practice Address - Street 2:SUITE A
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2702
Practice Address - Country:US
Practice Address - Phone:940-566-3368
Practice Address - Fax:940-382-1066
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX149521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice