Fereidon Wolfgang Manssuri, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

12053 Issued in MD

Practice address

134 Coursevall Drive
Centreville, MD 21617

Phone

(410) 758-1424

Fax

(410) 758-4380

NPI assigned

Apr 16, 2007

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

Other names 1

• Wolfgang Manssuri Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Feb 1, 2018 through Feb 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1447475140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 COURSEVALL DRIVE",
            "city": "CENTREVILLE",
            "state": "MD",
            "postal_code": "21617",
            "telephone_number": "410-758-1424",
            "fax_number": "410-758-4380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 COURSEVALL DRIVE",
            "city": "CENTREVILLE",
            "state": "MD",
            "postal_code": "21617",
            "telephone_number": "410-758-1424",
            "fax_number": "410-758-4380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANSSURI",
        "first_name": "FEREIDON",
        "middle_name": "WOLFGANG",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MD",
            "license": "12053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "WOLFGANG",
            "last_name": "MANSSURI",
            "credential": "D.D.S.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Sargam Raja Mahat, PHARMD
• Karen Moncure Maize
• Margaret Decker Malaro, M.D.
• Whitney Paige Mangum, LGSW
• Eric Matthew Maniago, MD
• Caryn Sue Martin, ED.D
• Lisa Hall McDonald, NP
• Margaret McKay, MS, CCC-SLP
• M Kim McSorley
• Molly Malone Melvin

• Dentist in Centreville, MD
• Providers in Centreville, MD by specialty
• Dentist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.