Individual
BIANCA MANISCALCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2821 GRAND AVE, WAUKEGAN, IL 60085-2372
(847) 662-4400
Mailing address
761 HARRISON AVE APT 407, BOSTON, MA 02118-3478
(630) 450-6391
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.035496
IL
390200000X
Student in an Organized Health Care Education/Training Program
390200000X
MA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/06/2023
Last updated
08/28/2024
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