Provider Demographics
NPI:1750380283
Name:CUTBIRTH, MANCE A (DDS,MD)
Entity type:Individual
Prefix:DR
First Name:MANCE
Middle Name:A
Last Name:CUTBIRTH
Suffix:
Gender:M
Credentials:DDS,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5756 S STAPLES
Mailing Address - Street 2:ST F
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-3796
Mailing Address - Country:US
Mailing Address - Phone:361-993-2290
Mailing Address - Fax:361-992-4961
Practice Address - Street 1:5756 S STAPLES ST
Practice Address - Street 2:ST F
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3796
Practice Address - Country:US
Practice Address - Phone:361-993-2290
Practice Address - Fax:361-992-4961
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ94841223S0112X
TX162551223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD16255OtherDELTA TX CHIPS
TX173354OtherUNITED CONCORDIA
TXJ9484OtherMEDICAL LIC #
TXJ9484OtherMEDICAL LIC #
TX173354OtherUNITED CONCORDIA
TXJ9484OtherMEDICAL LIC #