MEDICARE: DR. ANDREW MANCIN

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	2014031160	MO

General Provider Information

NPI Number	:	1659773588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW MANCIN

Provider Business Mailing Address
First Line	:	7229 N OAK TRFY
Second Line	:
City	:	GLADSTONE
State	:	MO
Zip	:	64118-1852
Country	:	US
Telephone Number	:	816-436-0354
Fax Number	:

Provider Business Practice Location Address
First Line	:	7229 N OAK TRFY
Second Line	:
City	:	GLADSTONE
State	:	MO
Zip	:	64118-1852
Country	:	US
Telephone Number	:	816-436-0354
Fax Number	:

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

Provider Enumeration Date	:	09/23/2014
Last Update Date	:	09/23/2014

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