Individual
JOHN MANNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1363 W LANE RD, MACHESNEY PARK, IL 61115-1621
(815) 637-2800
Mailing address
880 BRISTOL DR, BARRINGTON, IL 60010-4507
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.028879
IL
Other
Enumeration date
10/14/2011
Last updated
01/05/2012
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