Provider Demographics
NPI:1629338611
Name:MANCIA, JORGE BENJAMIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:BENJAMIN
Last Name:MANCIA
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 1:1274 5TH AVE
Mailing Address - Street 2:APT 608
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-3435
Mailing Address - Country:US
Mailing Address - Phone:305-342-7926
Mailing Address - Fax:
Practice Address - Street 1:11 YORKSHIRE ST STE A
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803
Practice Address - Country:US
Practice Address - Phone:305-342-7926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC115591223S0112X
NY0567701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery