MEDICARE: JOSH MANSFIELD DDS, PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1215624267
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSH MANSFIELD DDS, PLLC

Provider Business Mailing Address
First Line	:	809 MARSHALL RD
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-3744
Country	:	US
Telephone Number	:	501-982-4444
Fax Number	:	501-982-6616

Provider Business Practice Location Address
First Line	:	809 MARSHALL RD
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-3744
Country	:	US
Telephone Number	:	501-982-4444
Fax Number	:	501-982-6616

Authorized Official
Title or Position	:	OWNER
Name	:	JOSH MANSFIELD
Credential	:	DDS
Telephone Number	:	501-982-4444

Provider Enumeration Date	:	04/20/2023
Last Update Date	:	04/20/2023

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