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NPI Code Detail

MEDICARE: DREW MANSON

MEDICARE: DREW MANSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QD0000XDental Clinic/Center019017059IL

General Provider Information

NPI Number : 1033386107
Entity Type Code : Organization
Provider Name (Legal Business Name) : DREW MANSON
Provider Business Mailing Address
First Line : 3936 N CENTRAL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60634-2732
Country : US
Telephone Number : 773-685-3933
Fax Number :
Provider Business Practice Location Address
First Line : 3936 N CENTRAL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60634-2732
Country : US
Telephone Number : 773-685-3933
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. DREW MANSON
Credential : DDS
Telephone Number : 773-685-3933
Provider Enumeration Date : 05/08/2008
Last Update Date : 05/08/2008

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