Provider Demographics
NPI:1548325681
Name:PHILIP M MANSOUR DMD PLLC
Entity type:Organization
Organization Name:PHILIP M MANSOUR DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANSOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-497-4605
Mailing Address - Street 1:89 SOUTH MAST ST
Mailing Address - Street 2:
Mailing Address - City:GOFFSTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03045
Mailing Address - Country:US
Mailing Address - Phone:603-417-4605
Mailing Address - Fax:603-497-3327
Practice Address - Street 1:89 SOUTH MAST ST
Practice Address - Street 2:
Practice Address - City:GOFFSTOWN
Practice Address - State:NH
Practice Address - Zip Code:03045
Practice Address - Country:US
Practice Address - Phone:603-417-4605
Practice Address - Fax:603-497-3327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA171931223X0400X
NH24361223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty