NPIMap

Organization Active NPI

Mangram Dental, P.C.

  • General Practice Dentistry
  • Chicago Heights, IL
National Provider Identifier
1659779569
Registry record updated Dec 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019026308 Issued in IL
Legal business name
MANGRAM DENTAL, P.C.
Doing business as
Lincoln Crossing Family Dental
Practice address
647 W Lincoln Hwy
Suite B
Chicago Heights, IL 60411-2374
Phone
(708) 996-1111
NPI assigned
Dec 9, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2014

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

Authorized official

Name
Dr. Treneice Mangram, D.D.S.
Title
President/Dentist
Phone
(708) 799-4203

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 019026308 IL Primary

Addresses

Primary practice location

647 W Lincoln Hwy
Suite B
Chicago Heights, IL 60411-2374

Mailing address

1321 Rosewood CT
Flossmoor, IL 60422-1471
Phone (708) 799-4203

Other names 1

  • Lincoln Crossing Family Dental Doing business as

National Provider Directory

National Provider Directory

Locations

647 W Lincoln Hwy
Ste B
Chicago Heights, IL 60411
Phone (708) 996-1111

NPI Registry JSON

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

{
    "created_epoch": "1418083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418083200000",
    "number": "1659779569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1321 ROSEWOOD CT",
            "city": "FLOSSMOOR",
            "state": "IL",
            "postal_code": "604221471",
            "telephone_number": "708-799-4203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "647 W LINCOLN HWY",
            "address_2": "SUITE B",
            "city": "CHICAGO HEIGHTS",
            "state": "IL",
            "postal_code": "604112374",
            "telephone_number": "708-996-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANGRAM DENTAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-09",
        "last_updated": "2014-12-09",
        "status": "A",
        "authorized_official_last_name": "MANGRAM",
        "authorized_official_first_name": "TRENEICE",
        "authorized_official_title_or_position": "PRESIDENT/DENTIST",
        "authorized_official_telephone_number": "708-799-4203",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019026308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lincoln Crossing Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago Heights, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2014; 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.