Provider Demographics
NPI:1518608629
Name:GABRIEL T. MANCUSO, DMD PLLC
Entity Type:Organization
Organization Name:GABRIEL T. MANCUSO, DMD PLLC
Other - Org Name:PHILIPSBURG DENTAL PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FETZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-342-1090
Mailing Address - Street 1:101 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:PHILIPSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16866-1603
Mailing Address - Country:US
Mailing Address - Phone:814-342-1090
Mailing Address - Fax:814-343-2597
Practice Address - Street 1:101 N FRONT ST
Practice Address - Street 2:
Practice Address - City:PHILIPSBURG
Practice Address - State:PA
Practice Address - Zip Code:16866-1603
Practice Address - Country:US
Practice Address - Phone:814-342-1090
Practice Address - Fax:814-343-2597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty