Provider Demographics
NPI:1689112336
Name:ROBERT R MANTONI DDS AND ASSOCIATES III PC
Entity Type:Organization
Organization Name:ROBERT R MANTONI DDS AND ASSOCIATES III PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:MANTONI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-228-2980
Mailing Address - Street 1:110 DORCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-1915
Mailing Address - Country:US
Mailing Address - Phone:410-228-2980
Mailing Address - Fax:410-228-8283
Practice Address - Street 1:110 DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1915
Practice Address - Country:US
Practice Address - Phone:410-228-2980
Practice Address - Fax:410-228-8283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD6702122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty