Mohamed Shady Mansour, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS039173 Issued in PA

Practice address

123 N 13TH St
Allentown, PA 18102-3758

Phone

(773) 459-6783

NPI assigned

Aug 29, 2012

Sex

Male

Sole proprietor

No

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

Enrolled in PA

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

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

{
    "created_epoch": "1346198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578700800000",
    "number": "1538418108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 WELL SWEEP RD",
            "city": "WHITEHOUSE STATION",
            "state": "NJ",
            "postal_code": "088893250",
            "telephone_number": "773-459-6783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 N 13TH ST",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181023758",
            "telephone_number": "773-459-6783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANSOUR",
        "first_name": "MOHAMED",
        "middle_name": "SHADY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-29",
        "last_updated": "2020-01-11",
        "certification_date": "2020-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI02509300",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS039173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kailyn Irene Mann, D.O
• Manor Care of Allentown PA, LLC (ProMedica Skilled Nursing and Rehabilitation (Allentown))
• Ather Mansoor, M.D., M.H.A.
• Shoaib Mansoor
• Ahmed Mahmoud Mansour, MD
• Erin P Mantilla, PA
• Maryanne Manula-Kosciolek, MS; LPC
• Lisa Marie Manzo, LCSW
• Holly Brader Marakovits, CRNP
• Patricia Maran, M.D.

• General Practice Dentistry in Allentown, PA
• Providers in Allentown, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2020; 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.