Provider Demographics
NPI:1831491505
Name:MANSEY, MATTHEW J (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:J
Last Name:MANSEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W WASHINGTON AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-2190
Mailing Address - Country:US
Mailing Address - Phone:908-689-0825
Mailing Address - Fax:908-689-7456
Practice Address - Street 1:315 W WASHINGTON AVE STE 6
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-2190
Practice Address - Country:US
Practice Address - Phone:908-689-0825
Practice Address - Fax:908-689-7456
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02460800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist