Most Relevant Information
Provider Data
| NPI Number: | 1003535030 |
| Provider Name: | MARIA MANCUSO |
| Entity Type: | Individual |
| Taxonomy Code: | 124Q00000X |
| Specialty: | Dental Hygienist |
| License Number: | 017103-01 |
Most Important Dates
| Enumeration Date: | 08/23/2022 |
| Last Updated: | 08/23/2022 |
Provider Practice Location
11714 SW WESTCLIFFE LN
PORT ST LUCIE
FL
349872106
Practice Location Phone/Fax
| Phone: | 6312783397 |
| Fax: |
Provider Mailing Location
11714 SW WESTCLIFFE LN
PORT ST LUCIE
FL
349872106
Provider Mailing Phone/Fax
| Phone: | 6312783397 |
| Fax: |