Healthcare Provider Details

I. General information

NPI: 1740367911
Provider Name (Legal Business Name): BRYAN F MANSOUR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E ROMIE LN SUITE B
SALINAS CA
93901-3158
US

IV. Provider business mailing address

130 E ROMIE LN SUITE B
SALINAS CA
93901-3158
US

V. Phone/Fax

Practice location:
  • Phone: 831-783-3131
  • Fax:
Mailing address:
  • Phone: 831-783-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number031662
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: