Provider Demographics
NPI:1740476894
Name:MANCINI, ANN MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:ANN MARIE
Middle Name:
Last Name:MANCINI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 LAKESIDE BLVD E
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2968
Mailing Address - Country:US
Mailing Address - Phone:203-575-9097
Mailing Address - Fax:
Practice Address - Street 1:26 LAKESIDE BLVD E
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2968
Practice Address - Country:US
Practice Address - Phone:203-575-9097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-22
Last Update Date:2007-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0097411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice