MEDICARE: DR. MATTHEW EUGENE MANSFIELD 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	2000157567	MO

General Provider Information

NPI Number	:	1912151960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW EUGENE MANSFIELD DDS

Provider Business Mailing Address
First Line	:	PO BOX 2
Second Line	:
City	:	WILLOW SPRINGS
State	:	MO
Zip	:	65793
Country	:	US
Telephone Number	:	417-469-2030
Fax Number	:	417-469-5085

Provider Business Practice Location Address
First Line	:	2729 STATE ROUTE 76 WEST
Second Line	:
City	:	WILLOW SPRINGS
State	:	MO
Zip	:	65793
Country	:	US
Telephone Number	:	417-469-2030
Fax Number	:	417-469-5085

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

Provider Enumeration Date	:	11/04/2008
Last Update Date	:	11/04/2008

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