Provider Demographics
NPI:1912151960
Name:MANSFIELD, MATTHEW EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:EUGENE
Last Name:MANSFIELD
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:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:65793
Mailing Address - Country:US
Mailing Address - Phone:417-469-2030
Mailing Address - Fax:417-469-5085
Practice Address - Street 1:2729 STATE ROUTE 76 WEST
Practice Address - Street 2:
Practice Address - City:WILLOW SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:65793
Practice Address - Country:US
Practice Address - Phone:417-469-2030
Practice Address - Fax:417-469-5085
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000157567122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist