Provider Demographics
NPI:1134535081
Name:MANTOR, BRIAN PAUL (DMD, MSD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:PAUL
Last Name:MANTOR
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1836
Mailing Address - Country:US
Mailing Address - Phone:702-259-1943
Mailing Address - Fax:702-877-2727
Practice Address - Street 1:3811 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1836
Practice Address - Country:US
Practice Address - Phone:702-259-1943
Practice Address - Fax:702-877-2727
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV65071223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics