Provider Demographics
NPI:1205127347
Name:DRS. MANCUSO & MANCUSO P.C.
Entity type:Organization
Organization Name:DRS. MANCUSO & MANCUSO P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MANCUSO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-397-7799
Mailing Address - Street 1:7930 BLONDO ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-6661
Mailing Address - Country:US
Mailing Address - Phone:402-397-7799
Mailing Address - Fax:
Practice Address - Street 1:7930 BLONDO ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-6661
Practice Address - Country:US
Practice Address - Phone:402-397-7799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-24
Last Update Date:2011-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE50751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty