Mantis Dentistry & Implant Center

Primary specialty

DentistTaxonomy code 122300000X

License

019020682 Issued in IL

Legal business name

MANTIS DENTISTRY & IMPLANT CENTER

Practice address

1625 Sheridan Rd
Wilmette, IL 60091-1824

Phone

(847) 256-4776

NPI assigned

Mar 20, 2017

Organization subpart

No

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

Authorized official

Name

Konstantino Mantis, DDS

Title

Dentist

Phone

(847) 256-4776

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1489968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489968000000",
    "number": "1134660392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1625 SHERIDAN RD",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600911824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 SHERIDAN RD",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600911824",
            "telephone_number": "847-256-4776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANTIS DENTISTRY & IMPLANT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-20",
        "last_updated": "2017-03-20",
        "status": "A",
        "authorized_official_last_name": "MANTIS",
        "authorized_official_first_name": "KONSTANTINO",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "847-256-4776",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019020682",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Miyeita Giselle Magee, NP
• Jonathan H Maks, MD
• Marissa Mallinckrodt, NP
• Megan Malyszek
• Manor Care of Wilmette Il, LLC
• Konstantino J Mantis, D.D.S.
• Stacey Anne Marguerite, PT
• Pamela Margules, MA, LCSW
• Laura Markoya, LSW
• Shelby Marshall, CNM

• Dentist in Wilmette, IL
• Providers in Wilmette, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 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.