Dr. Gary W. Mancewicz DDS

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

Last updated

Apr 30, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Gary W Mancewicz, DDSNPI 1801966767

Title

Owner/Dentist

Phone

(616) 455-3020

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gary W. Mancewicz, D.D.S.

  • Dentist
  • Grand Rapids, MI
  • NPI 1801966767
  Authorized official Same address or phone

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": [],
    "endpoints": [],
    "other_names": []
}

• Jacquie Dominguez
• Sarah Rae Domke
• Samantha Doorn
• Kenisha Sheree Dorsey, MSW
• Ruth Douglas
• Dream Big Dental, PLLC (Kentwood Premier Dentistry)
• Cory Jon Driesenga, RPH
• DRS May and Mallory DDS PC (Breton Gardens Family Dentistry)
• Anna Stankovich Dubiak
• Duncan Lake Speech Therapy, LLC (Duncan Lake Counseling Collective)

• 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 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.