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General NPI Number Information
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NPI Number | 1518608629
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Entity Type | Organization
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Legal Business Name | GABRIEL T. MANCUSO, DMD PLLC
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 101 N FRONT ST
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City | PHILIPSBURG
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State | PA
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Zip | 16866-1603
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Country | US
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Telephone | 814-342-1090
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Fax | 814-343-2597
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Provider Business Mailing Address
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Address Line | 101 N FRONT ST
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City | PHILIPSBURG
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State | PA
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Zip | 16866-1603
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Country | US
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Telephone | 814-342-1090
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Fax | 814-343-2597
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MICHELLE FETZER
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Credential |
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Telephone | 814-342-1090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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