NPIMap

Organization Active NPI

Dr. Gary W. Mancewicz DDS

  • General Practice Dentistry
  • Kentwood, MI
National Provider Identifier
1346508124
Registry record updated Apr 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2901011327 Issued in MI
Legal business name
DR. GARY W. MANCEWICZ DDS
Practice address
2351 Countrywood Dr SE
Kentwood, MI 49508-5295
Phone
(616) 455-3020
Fax
(616) 455-1397
NPI assigned
Apr 30, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2012

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

Authorized official

Name
Mr. Gary W Mancewicz, DDS
Title
Owner/Dentist
Phone
(616) 455-3020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 2901011327 MI Primary

Addresses

Primary practice location

2351 Countrywood Dr SE
Kentwood, MI 49508-5295

Mailing address

2351 Countrywood Dr SE
Kentwood, MI 49508-5295
Phone (616) 455-3020

Other identifiers 1

IdentifierTypeStateIssuer
4828774MedicaidMI

National Provider Directory

National Provider Directory

Locations

2351 Countrywood Dr SE
Kentwood, MI 49508
Phone (616) 455-3020

NPI Registry JSON

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

{
    "created_epoch": "1335744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335744000000",
    "number": "1346508124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2351 COUNTRYWOOD DR SE",
            "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",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495085295",
            "telephone_number": "616-455-3020",
            "fax_number": "616-455-1397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. GARY W. MANCEWICZ DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-30",
        "last_updated": "2012-04-30",
        "status": "A",
        "authorized_official_last_name": "MANCEWICZ",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "616-455-3020",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901011327",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4828774",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kentwood, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2012; 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.