=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154538312
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARGIE L MANNERING DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 E WASHINGTON ST SUITE 3005
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-456-0221
-----------------------------------------------------
Fax | 312-456-0224
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 838 W BARRY
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-868-1975
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 19017234
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------