Gary W. Mancewicz, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

29-01-011327 Issued in MI

Practice address

2351 Countrywood Dr SE
Suite B
Grand Rapids, MI 49508-5065

Phone

(616) 455-3020

Fax

(616) 455-1397

NPI assigned

Nov 8, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1801966767",
    "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": "FM",
            "postal_code": "49508",
            "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": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495085065",
            "telephone_number": "616-455-3020",
            "fax_number": "616-455-1397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANCEWICZ",
        "first_name": "GARY",
        "middle_name": "W.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "29-01-011327",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4828774",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rolland Dean Mambourg, MD
• Laura Danielle Mammen, LPC, LMFT, NCC, ACS
• Managed Senior Care LLC
• Michelle Mascarinas Manalac, MD
• Amanda Mancewicz, PHARMD
• Alicia May Mancini, PA-C
• Brandon Robert Mancini, M.D.
• Anjali Modi Mander, M.D.
• Navneet Singh Mander, M.D.
• Amy Manderscheid, DNP, RN, AGPCNP-BC

• Dentist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.