Provider Demographics
NPI:1730221862
Name:MANSFIELD FAMILY DENTISTRY,PA
Entity type:Organization
Organization Name:MANSFIELD FAMILY DENTISTRY,PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-298-5800
Mailing Address - Street 1:23659 COLUMBUS RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:COLUMBUS
Mailing Address - State:NJ
Mailing Address - Zip Code:08022-1979
Mailing Address - Country:US
Mailing Address - Phone:609-298-5800
Mailing Address - Fax:609-298-6895
Practice Address - Street 1:23659 COLUMBUS RD
Practice Address - Street 2:SUITE 1
Practice Address - City:COLUMBUS
Practice Address - State:NJ
Practice Address - Zip Code:08022-1979
Practice Address - Country:US
Practice Address - Phone:609-298-5800
Practice Address - Fax:609-298-6895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0174511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty