MEDICARE: DR. GEORGE E MANTELL 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	1223G0001X	General Practice Dentistry	D2793	AZ

General Provider Information

NPI Number	:	1932262524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE E MANTELL DDS

Provider Business Mailing Address
First Line	:	4877 N VENTANA RIDGE PL
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85750-6066
Country	:	US
Telephone Number	:	520-795-2123
Fax Number	:	520-795-3214

Provider Business Practice Location Address
First Line	:	2910 N SWAN RD
Second Line	:	SUITE 107
City	:	TUCSON
State	:	AZ
Zip	:	85712-6011
Country	:	US
Telephone Number	:	520-795-2123
Fax Number	:	520-795-3214

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	07/08/2007

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