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General NPI Number Information
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NPI Number | 1811161342
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Entity Type | Organization
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Legal Business Name | GREGORY J. MANSOUR, D.D.S., P.C.
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 1800 W AUBURN RD
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City | ROCHESTER HILLS
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State | MI
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Zip | 48309-3858
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Country | US
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Telephone | 248-852-3130
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 W AUBURN RD
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City | ROCHESTER HILLS
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State | MI
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Zip | 48309-3858
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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 | OWNER
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Name | GREGORY J. MANSOUR
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Credential |
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Telephone | 248-852-3130
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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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