Stephen Michael Mancewicz, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5315050258 Issued in MI

Practice address

2351 Countrywood Dr SE
Suite B
Kentwood, MI 49508-5295

Phone

(616) 455-3020

Fax

(616) 455-1397

NPI assigned

May 27, 2011

Last updated

May 27, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1306454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306454400000",
    "number": "1235422999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2351 COUNTRYWOOD DR SE",
            "address_2": "SUITE B",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495085295",
            "telephone_number": "616-455-3020",
            "fax_number": "616-455-1397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2351 COUNTRYWOOD DR SE",
            "address_2": "SUITE B",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495085295",
            "telephone_number": "616-455-3020",
            "fax_number": "616-455-1397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANCEWICZ",
        "first_name": "STEPHEN",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-05-27",
        "last_updated": "2011-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "5315050258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beth Macauley, PH.D., CCC-SLP, HPCS
• Evan Macdonald, LMT
• Swetha Madala, D.D.S
• Denise Maldonado
• Heather Anne Mallory-May, D.D.S.
• Dawn Elizabeth-Reed Mango, RN
• Easton Izaak Mann, PA-C
• Emily Anne Mannor
• Tyler Marcus
• Bailey Jean Marshall

• General Practice Dentistry in Kentwood, MI
• Providers in Kentwood, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2011; 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.