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General NPI Number Information
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NPI Number | 1639328677
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Entity Type | Individual
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Provider Name | JOHN MANTINAOS DMD
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Gender | Male
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Dates
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Enumeration Date | 09/15/2008
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Last Update Date | 10/23/2014
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Provider Practice Location Address
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Address Line | 5203 BROADWAY ST
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City | QUINCY
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State | IL
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Zip | 62305-9110
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Country | US
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Telephone | 217-577-2400
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Fax | 217-228-1032
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Provider Business Mailing Address
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Address Line | 5203 BROADWAY ST
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City | QUINCY
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State | IL
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Zip | 62305-9110
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Country | US
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Telephone | 217-577-2400
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Fax | 217-228-1032
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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 | 048817-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12011569A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019028483
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02373800
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License Number State | NJ
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Taxonomy #5
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS036424
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License Number State | PA
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Taxonomy #6
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN20160
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License Number State | MA
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