Active NPI
John Mannelly
- General Practice Dentistry
- Machesney Park, IL
National Provider Identifier
1881979466
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019.028879
- Practice address
- 1363 W Lane Rd
Machesney Park, IL 61115-1621 - Phone
- (815) 637-2800
- NPI assigned
- Oct 14, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019.028879 | IL | Primary |
Addresses
Primary practice location
1363 W Lane Rd
Machesney Park, IL 61115-1621
Mailing address
880 Bristol Dr
Barrington, IL 60010-4507
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.028879 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318550400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325721600000",
"number": "1881979466",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "880 BRISTOL DR",
"city": "BARRINGTON",
"state": "IL",
"postal_code": "600104507"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1363 W LANE RD",
"city": "MACHESNEY PARK",
"state": "IL",
"postal_code": "611151621",
"telephone_number": "815-637-2800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANNELLY",
"first_name": "JOHN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-10-14",
"last_updated": "2012-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019.028879",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Machesney Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 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.