MEDICARE: DR. ANDREW J MANTEL D.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	034441	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184777377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW J MANTEL D.M.D

Provider Business Mailing Address
First Line	:	15009 89TH ST
Second Line	:
City	:	HOWARD BEACH
State	:	NY
Zip	:	11414-1503
Country	:	US
Telephone Number	:	718-641-1333
Fax Number	:	718-641-9156

Provider Business Practice Location Address
First Line	:	15009 89TH ST
Second Line	:
City	:	HOWARD BEACH
State	:	NY
Zip	:	11414-1503
Country	:	US
Telephone Number	:	718-641-1333
Fax Number	:	718-641-9156

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	07/08/2007

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