Organization
DR. GARY W. MANCEWICZ DDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY W MANCEWICZ DDS (OWNER/DENTIST)
(616) 455-3020
Entity
Organization
Contact information
Practice address
2351 COUNTRYWOOD DR SE, KENTWOOD, MI 49508-5295
(616) 455-3020
(616) 455-1397
Mailing address
2351 COUNTRYWOOD DR SE, KENTWOOD, MI 49508-5295
(616) 455-3020
(616) 455-1397
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901011327
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4828774
—
MI
Enumeration date
04/30/2012
Last updated
04/30/2012
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