Brian Paul Mantor, DMD, MSD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

6507 Issued in NV

Practice address

3811 W Charleston Blvd
Suite 201
Las Vegas, NV 89102-1836

Phone

(702) 259-1943

Fax

(702) 877-2727

NPI assigned

Jul 10, 2014

Last updated

Jul 10, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Gifford Perio LTD

  dba Periodontics Limited

  • Periodontics
  • Las Vegas, NV
  • NPI 1619028800
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1404950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404950400000",
    "number": "1134535081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3811 W CHARLESTON BLVD",
            "address_2": "SUITE 201",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891021836",
            "telephone_number": "702-259-1943",
            "fax_number": "702-877-2727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3811 W CHARLESTON BLVD",
            "address_2": "SUITE 201",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891021836",
            "telephone_number": "702-259-1943",
            "fax_number": "702-877-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANTOR",
        "first_name": "BRIAN",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "DMD, MSD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-07-10",
        "last_updated": "2014-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NV",
            "license": "6507",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brooke Mantie, APRN FNP-BC
• Ana Miriam Mantilla, ND
• Richard C Mantin, MD
• Ashton Kirsten Mantolino, RN
• Melodie G Mantooth Null, LPN
• Mantro Mobile Imaging LLC
• Mantro Mobile Imaging LLC
• Jacob McKay Mantz, PHARM.D
• Jeanine Manubay, PT, DPT
• Lisset Manuel Garateix

• Periodontics in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Periodontics in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.