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General NPI Number Information
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NPI Number | 1538833900
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Entity Type | Individual
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Provider Name | JUNG MANTON
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Gender | Male
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Dates
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Enumeration Date | 08/09/2021
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Last Update Date | 08/09/2021
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Provider Practice Location Address
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Address Line | 385 EASTON RD STE B
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City | WARRINGTON
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State | PA
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Zip | 18976-2421
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Country | US
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Telephone | 267-665-9203
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Fax |
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Provider Business Mailing Address
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Address Line | 385 EASTON RD. STE B
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City | HORSHAM
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State | PA
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Zip | 18976
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS043135
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License Number State | PA
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