Provider Demographics
NPI:1316951049
Name:MANCIA, PAUL R (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:MANCIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 LAKESIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HARVEY'S LAKE
Mailing Address - State:PA
Mailing Address - Zip Code:18612
Mailing Address - Country:US
Mailing Address - Phone:570-331-0824
Mailing Address - Fax:570-331-0827
Practice Address - Street 1:500 3RD AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5810
Practice Address - Country:US
Practice Address - Phone:570-331-0824
Practice Address - Fax:570-331-0827
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017029-L1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT29192Medicare UPIN
PAMA117238Medicare ID - Type Unspecified