Victor R Mancuso, D.D.S., M.S.

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

D10405 Issued in OR

Practice address

6400 SE Lake Rd Ste 140
Portland, OR 97222-2194

Phone

(503) 496-4766

Fax

(503) 496-4700

NPI assigned

Sep 26, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

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

• Terry L Isom DMD,PC

  • Dental Clinic/Center
  • Portland, OR
  • NPI 1942013321
  NPD

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618358400000",
    "number": "1508967704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6400 SE LAKE RD STE 140",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972222194",
            "telephone_number": "503-496-4766",
            "fax_number": "503-496-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6400 SE LAKE RD STE 140",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972222194",
            "telephone_number": "503-496-4766",
            "fax_number": "503-496-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANCUSO",
        "first_name": "VICTOR",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2021-04-14",
        "certification_date": "2021-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "CA",
            "license": "37698",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "OR",
            "license": "D10405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Vincent Manchio, MD
• Judith E. Manchio, FNP-BC
• Andrea Mancini, CNM
• Megan Mancini
• Morgan Mancini, LPN
• Mandala Acupuncture & Bodywork. LLC
• Mandala Medicine Acupuncture LLC
• Mandala Mental and Behavioral Health, LLC
• David Mandala
• Elizabeth Ann Mandel, PNP

• Endodontics in Portland, OR
• Providers in Portland, OR by specialty
• Endodontics in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.