Cyrus Jon Mansouri, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

7473 Issued in LA

Practice address

5024 Keystone Blvd Ste a
Covington, LA 70433-7517

Phone

(985) 778-0241

NPI assigned

Jun 29, 2023

Last updated

Jul 23, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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 LA

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

State licenses

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.

• St. Tammany Periodontics & Implants LLC

  • Periodontics
  • Covington, LA
  • NPI 1104496744
  NPD (past)
• Gulf Coast Periodontics & Implants LLC

  • Periodontics
  • Gulfport, MS
  • NPI 1730759374
  NPD (past)

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

{
    "created_epoch": "1687996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784764800000",
    "number": "1376220517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6377 CANAL BLVD",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701243117",
            "telephone_number": "224-456-9191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5024 KEYSTONE BLVD STE A",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704337517",
            "telephone_number": "985-778-0241"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1414 Old Spanish Trl",
            "address_purpose": "LOCATION",
            "city": "Slidell",
            "state": "LA",
            "postal_code": "704585022",
            "country_code": "US",
            "telephone_number": "985-778-0241",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANSOURI",
        "first_name": "CYRUS",
        "middle_name": "JON",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-29",
        "last_updated": "2026-07-23",
        "certification_date": "2026-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "LA",
            "license": "7473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Harvey L Malone, MD
• Mandeville Private Physician Group
• Joshua Michael Manguno, LCSW
• Kelsey Hershey Manguno, MD
• Mistina Mano Manoharan
• Laiyatu E. B. Manya, PSYD
• Demetrius M Maraganore, M.D.
• Deairea Marchand, LOT
• Richard G Marek Jr., MD
• Jon William Mares, D.O.

• Periodontics in Covington, LA
• Providers in Covington, LA by specialty
• Periodontics in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2026; 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.