Individual
DR. GARY W. MANCEWICZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2351 COUNTRYWOOD DR SE, SUITE B, GRAND RAPIDS, MI 49508-5065
(616) 455-3020
(616) 455-1397
Mailing address
2351 COUNTRYWOOD DR. SE, SUITE B, KENTWOOD, FM 49508
(616) 455-3020
(616) 455-1397
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
29-01-011327
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4828774
—
MI
Enumeration date
11/08/2006
Last updated
07/08/2007
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