Mancera Dental LLC

Primary specialty

DentistTaxonomy code 122300000X

License

2015041029 Issued in MO

Legal business name

MANCERA DENTAL LLC

Practice address

281 Sanders Creek Pkwy
East Syracuse, NY 13057-1307

Phone

(315) 454-6000

Fax

(866) 803-4943

NPI assigned

Mar 17, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Heather Kraushaar

Title

Provider Relations Rep

Phone

(315) 454-6000

Specialties & licenses 1

Addresses

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mitchell Finder, DDS

  • General Practice Dentistry
  • Saint Louis, MO
  • NPI 1326787276
  NPD (past)
• Jerry Michael Hill Jr., DMD

  • Dentist
  • Farmington, MO
  • NPI 1750548905
  NPD (past)
• Ghulam Makhdoom, DDS

  • Dentist
  • Farmington, MO
  • NPI 1568353381
  NPD (past)
• Chintan Shukla, DMD

  • General Practice Dentistry
  • Springfield, PA
  • NPI 1134744063
  NPD (past)

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

{
    "created_epoch": "1489708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489708800000",
    "number": "1003357468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 W KARSCH BLVD",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636403342",
            "telephone_number": "573-705-3485",
            "fax_number": "573-747-0058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "281 SANDERS CREEK PKWY",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130571307",
            "telephone_number": "315-454-6000",
            "fax_number": "866-803-4943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANCERA DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-17",
        "last_updated": "2017-03-17",
        "status": "A",
        "authorized_official_last_name": "KRAUSHAAR",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "PROVIDER RELATIONS REP",
        "authorized_official_telephone_number": "315-454-6000"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MO",
            "license": "2015041029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Moore Malcolm, ANP-BC
• Ashley Malcomb
• Anastasia Mallore
• Emily Malone
• Anthony John Malvasi, D.O.
• Praveen Kumar Mandera Govindaiah, D.M.D
• Paul Manfredo
• Katelyn Mannara, DPT, PT
• Carole Anne Marascalchi, M.S., CCC-SLP
• Mark Antosh MD PC

• Dentist in East Syracuse, NY
• Providers in East Syracuse, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.