Provider Demographics
NPI:1831350735
Name:MANSFIELD DENTAL ASSOCIATES PA
Entity type:Organization
Organization Name:MANSFIELD DENTAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:BLAIR
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-473-6227
Mailing Address - Street 1:1700 COUNTRY CLUB DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-2615
Mailing Address - Country:US
Mailing Address - Phone:817-473-6227
Mailing Address - Fax:817-473-6919
Practice Address - Street 1:1700 COUNTRY CLUB DR
Practice Address - Street 2:SUITE A
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-2615
Practice Address - Country:US
Practice Address - Phone:817-473-6227
Practice Address - Fax:817-473-6919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13762122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty