MEDICARE: JOSEPH MANCINI SUSLIK DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0401416095	VA

General Provider Information

NPI Number	:	1508331539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH MANCINI SUSLIK DDS

Provider Business Mailing Address
First Line	:	6680 BALSAM ST
Second Line	:
City	:	ARVADA
State	:	CO
Zip	:	80004-3316
Country	:	US
Telephone Number	:	757-289-5758
Fax Number	:

Provider Business Practice Location Address
First Line	:	1555 S WADSWORTH BLVD STE 1
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80232-6830
Country	:	US
Telephone Number	:	303-986-9522
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2018
Last Update Date	:	12/09/2025

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