MEDICARE: MARGIE L. MANNERING, D.D.S.

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	1223G0001X	General Practice Dentistry	19017234	IL

General Provider Information

NPI Number	:	1952676652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARGIE L. MANNERING, D.D.S.

Provider Business Mailing Address
First Line	:	55 E WASHINGTON ST
Second Line	:	SUITE 3005
City	:	CHICAGO
State	:	IL
Zip	:	60602-2103
Country	:	US
Telephone Number	:	312-456-0221
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 E WASHINGTON ST
Second Line	:	SUITE 3005
City	:	CHICAGO
State	:	IL
Zip	:	60602-2103
Country	:	US
Telephone Number	:	312-456-0221
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. MARGIE L MANNERING
Credential	:	D.D.S.
Telephone Number	:	312-456-0221

Provider Enumeration Date	:	03/13/2012
Last Update Date	:	03/13/2012

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