Active NPI
Comprehensive & Cosmetic & General Dististry
- Dentist
- Wall Township, NJ
National Provider Identifier
1104930668
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 11320
- Legal business name
- COMPREHENSIVE & COSMETIC & GENERAL DISTISTRY
- Practice address
- 3350 State Route 138
Ste 127
Wall Township, NJ 07719-9693 - Phone
- (732) 556-9600
- Fax
- (732) 556-9601
- NPI assigned
- Aug 19, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Anthony Joseph Mancino, DDS
- Title
- Owner,President
- Phone
- (732) 556-9600
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 11320 | NJ | Primary |
Addresses
Primary practice location
3350 State Route 138
Ste 127
Wall Township, NJ 07719-9693
Mailing address
3350 State Route 138
Ste 127
Wall Township, NJ 07719-9693
Phone (732) 556-9600
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11320 | Other | NJ | INS CO'S |
| 90730-00-4 | Other | NJ | NJ EMPLOYER ID |
National Provider Directory
National Provider DirectoryLocations
3350 State Route 138
Ste 127
Wall Township, NJ 07719
Phone (732) 556-9600
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Dentist
- Wall Township, NJ
- NPI 1144608530
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155945600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1430870400000",
"number": "1104930668",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3350 STATE ROUTE 138",
"address_2": "STE 127",
"city": "WALL TOWNSHIP",
"state": "NJ",
"postal_code": "077199693",
"telephone_number": "732-556-9600",
"fax_number": "732-556-9601"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3350 STATE ROUTE 138",
"address_2": "STE 127",
"city": "WALL TOWNSHIP",
"state": "NJ",
"postal_code": "077199693",
"telephone_number": "732-556-9600",
"fax_number": "732-556-9601"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COMPREHENSIVE & COSMETIC & GENERAL DISTISTRY",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-19",
"last_updated": "2015-05-06",
"status": "A",
"authorized_official_last_name": "MANCINO",
"authorized_official_first_name": "ANTHONY",
"authorized_official_middle_name": "JOSEPH",
"authorized_official_title_or_position": "OWNER,PRESIDENT",
"authorized_official_telephone_number": "732-556-9600",
"authorized_official_credential": "DDS"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist",
"state": "NJ",
"license": "11320",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INS CO'S",
"identifier": "11320",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NJ EMPLOYER ID",
"identifier": "90730-00-4",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wall Township, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.