MEDICARE: DR. MARGIE L MANNERING DDS

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
1	122300000X	Dentist	19017234	IL

General Provider Information

NPI Number	:	1154538312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARGIE L MANNERING DDS

Provider Business Mailing Address
First Line	:	838 W BARRY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657
Country	:	US
Telephone Number	:	773-868-1975
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 E WASHINGTON ST
Second Line	:	SUITE 3005
City	:	CHICAGO
State	:	IL
Zip	:	60602
Country	:	US
Telephone Number	:	312-456-0221
Fax Number	:	312-456-0224

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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