Provider Demographics
NPI:1194995399
Name:MANTE, MAMLE (DMD)
Entity type:Individual
Prefix:
First Name:MAMLE
Middle Name:
Last Name:MANTE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5828 B MARKET STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-3114
Mailing Address - Country:US
Mailing Address - Phone:215-747-6901
Mailing Address - Fax:215-747-6907
Practice Address - Street 1:5828 B MARKET STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-3114
Practice Address - Country:US
Practice Address - Phone:215-747-6901
Practice Address - Fax:215-747-6907
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028162L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice