Provider Demographics
NPI:1477652402
Name:MANCINI, KEVIN JOHN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JOHN
Last Name:MANCINI
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 1:224 HAMPSTEAD VLG
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-8254
Mailing Address - Country:US
Mailing Address - Phone:910-270-3334
Mailing Address - Fax:800-705-1882
Practice Address - Street 1:224 HAMPSTEAD VLG
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-8254
Practice Address - Country:US
Practice Address - Phone:910-270-3334
Practice Address - Fax:800-705-1882
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC70061223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990171Medicaid
NC90171OtherBLUE CROSS BLUE SHIELD NC
NC90171OtherBLUE CROSS BLUE SHIELD NC