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General NPI Number Information
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NPI Number | 1639619323
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Entity Type | Organization
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Legal Business Name | MANHATTAN FAMILY DENTISTRY AND ORTHODONTICS
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Dates
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Enumeration Date | 03/01/2017
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Last Update Date | 03/02/2017
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Provider Practice Location Address
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Address Line | 24600 S US HIGHWAY 52 2D
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City | MANHATTAN
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State | IL
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Zip | 60442-9007
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Country | US
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Telephone | 815-478-9891
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Fax |
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Provider Business Mailing Address
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Address Line | 24600 S ROUTE 52 2D
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City | MANHATTAN
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State | IL
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Zip | 60442
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | CHRISTIAN FOLTYS
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Credential | D.D.S.
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Telephone | 815-478-9891
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019021119
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License Number State | IL
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