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General NPI Number Information
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NPI Number | 1164001509
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Entity Type | Individual
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Provider Name | RYAN MANCUSO DDS
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Gender | Male
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Dates
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Enumeration Date | 04/05/2021
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Last Update Date | 07/23/2022
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Provider Practice Location Address
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Address Line | 329 S MAIN ST
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City | CANANDAIGUA
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State | NY
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Zip | 14424-2118
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Country | US
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Telephone | 854-716-7845
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Fax |
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Provider Business Mailing Address
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Address Line | 2450 COUNTY ROAD 28 UNIT K3
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City | CANANDAIGUA
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State | NY
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Zip | 14424-8185
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Country | US
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Telephone | 716-581-2963
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Fax |
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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 | 062418
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License Number State | NY
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