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General NPI Number Information
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NPI Number | 1124120191
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Entity Type | Individual
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Provider Name | ROBERT WILLIAM MANSMAN, II II DDS
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Gender | Male
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 12/06/2011
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Provider Practice Location Address
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Address Line | 7360 GUILFORD DRIVE, SUITE #102 PEDIATRIC DENTAL CENTER OF FREDERICK
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City | FREDERICK
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State | MD
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Zip | 21704
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Country | US
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Telephone | 301-668-2662
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Fax | 301-668-6130
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Provider Business Mailing Address
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Address Line | 7360 GUILFORD DRIVE, SUITE #102 PEDIATRIC DENTAL CENTER OF FREDERICK
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City | FREDERICK
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State | MD
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Zip | 21704
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Country | US
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Telephone | 301-668-2662
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Fax | 301-668-6130
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401411486
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 14165
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License Number State | MD
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