Active NPI
Philippe Mansour, DMD
- Dentist
- Joint Base Lewis McChord, WA
National Provider Identifier
1932727476
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN016045
- Practice address
- 3740 South 14TH St
Joint Base Lewis-McChord, WA 98433 - Phone
- (253) 967-5271
- NPI assigned
- Jul 10, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN016045 | GA | Primary |
Addresses
Primary practice location
3740 South 14TH St
Joint Base Lewis-McChord, WA 98433
Mailing address
1341 Dukes Creek Dr NW
Kennesaw, GA 30152-8232
Phone (404) 769-0216
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN016045 | GA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594339200000",
"number": "1932727476",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1341 DUKES CREEK DR NW",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301528232",
"telephone_number": "404-769-0216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3740 SOUTH 14TH ST",
"city": "JOINT BASE LEWIS-MCCHORD",
"state": "WA",
"postal_code": "98433",
"telephone_number": "253-967-5271"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANSOUR",
"first_name": "PHILIPPE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-07-10",
"last_updated": "2020-07-10",
"certification_date": "2020-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "DN016045",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Joint Base Lewis McChord, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.