Provider Demographics
NPI:1629283544
Name:MANTINI, ERNEST JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:JAMES
Last Name:MANTINI
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 1:306 OWEN DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3514
Mailing Address - Country:US
Mailing Address - Phone:814-266-8805
Mailing Address - Fax:
Practice Address - Street 1:316 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAVIDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15928-9500
Practice Address - Country:US
Practice Address - Phone:814-479-4525
Practice Address - Fax:814-479-2615
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-023680-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009354800004Medicaid