Provider Demographics
NPI:1972571016
Name:MANCUSO, GERALD JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:JOHN
Last Name:MANCUSO
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 1:7930 BLONDO ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-6661
Mailing Address - Country:US
Mailing Address - Phone:402-397-7799
Mailing Address - Fax:
Practice Address - Street 1:7930 BLONDO ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-6661
Practice Address - Country:US
Practice Address - Phone:402-397-7799
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5075122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist