Provider Demographics
NPI:1508933813
Name:MANTHEI, BERNARD MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:MICHAEL
Last Name:MANTHEI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:B MICHAEL
Other - Middle Name:
Other - Last Name:MANTHEI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1814 NO ST PAUL ROAD
Mailing Address - Street 2:MAPLEWOOD MEDICAL AND PROFESSIONAL BLDG
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-4796
Mailing Address - Country:US
Mailing Address - Phone:651-770-2381
Mailing Address - Fax:651-770-2397
Practice Address - Street 1:1814 NO ST PAUL ROAD
Practice Address - Street 2:MAPLEWOOD MEDICAL AND PROFESSIONAL BLDG
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-4796
Practice Address - Country:US
Practice Address - Phone:651-770-2381
Practice Address - Fax:651-770-2397
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7439122300000X
CA21164122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist