Organization
MANGRAM DENTAL, P.C.
Active
Other names
Lincoln Crossing Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRENEICE MANGRAM D.D.S. (PRESIDENT/DENTIST)
(708) 799-4203
Entity
Organization
Contact information
Practice address
647 W LINCOLN HWY, SUITE B, CHICAGO HEIGHTS, IL 60411-2374
(708) 996-1111
Mailing address
1321 ROSEWOOD CT, FLOSSMOOR, IL 60422-1471
(708) 799-4203
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019026308
IL
Other
Enumeration date
12/09/2014
Last updated
12/09/2014
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