MANGRAM DENTAL, P.C. (NPI# 1659779569) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659779569 |
| Entity Type | Organization |
| Organization Name | MANGRAM DENTAL, P.C. |
| Other Organization Name | LINCOLN CROSSING FAMILY DENTAL |
| Practice Address |
647 W Lincoln Hwy Suite B Chicago Heights IL 60411-2374 |
| Mailing Address |
1321 Rosewood Ct Flossmoor IL 60422-1471 |
| Practice Telephone | 7089961111 |
| Mailing Telephone | 7087994203 |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2014-12-09 |
| Authorized Official Name | DR. TRENEICE MANGRAM (PRESIDENT/DENTIST) |
| Authorized Official Telephone | 7087994203 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
019026308 | IL | Dental Providers |
| Other Name | Type Code |
|---|---|
| Lincoln Crossing Family Dental | Doing Business As Name - Organization |
| Street Address |
647 W LINCOLN HWY SUITE B |
| City | CHICAGO HEIGHTS |
| State | IL |
| Zip Code | 60411-2374 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164044236 | Bryant Healthy Living, LLC | Nurse Practitioner | 19404 N. Creek Drive, Lynwood, IL 60411 | 2020-05-12 |
| 1235657263 | Natisha Olaseni | Case Manager/Care Coordinator | 641 W. 63rd Street, Chicago, IL 60411 | 2017-08-30 |
| 1033644497 | Fresenius Medical Care Chicagoland, LLC | Clinic/Center | 15 E. Independence Drive, Chicago Heights, IL 60411 | 2017-04-24 |
| 1992251771 | Latonya West | Counselor | 1640 215th Pl, Sauk Village, IL 60411 | 2016-08-31 |
| 1063868586 | Oho and Associates | Non-emergency Medical Transport (VAN) | 1010 S. Dixie Hwy, Chicago Heights, IL 60411 | 2016-05-13 |
| 1578945309 | Albert Ellis Jr. | Counselor | 395 West Lincoln Highway, Chicago Heights, IL 60411 | 2015-06-29 |
| 1407238181 | Stephanie Touney | Behavioral Analyst | 450 West 14th Street, Chicago Heights, IL 60411 | 2015-06-18 |
| 1851788582 | Dlw Transporation Corp | Non-emergency Medical Transport (VAN) | 603 Andover, Chicago H.t.s., IL 60411 | 2015-04-21 |
| 1215338983 | Stephanie Anderson-bell | Occupational Therapist | 630 Ranger Dr., Chicago Heights, IL 60411 | 2014-09-11 |
| 1255778221 | Aunt Martha's Youth Service Center, Inc | Clinic/Center | 500 Dixie Highway, Chicago Heights, IL 60411 | 2013-05-30 |
| Find all providers in zip 60411 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699121186 | Tiffany Townsel | Dentist | 567 W 14th St Unit C, Chicago Heights, IL 60411-2323 | 2016-05-13 |
| 1487967394 | Dominick Cannata | Dentist | 500 Ashland Ave Ste 1, Chicago Heights, IL 60411-3024 | 2010-07-20 |
| 1659524320 | Dwight E Thompson | Dentist | 567 W. 14th St., Units D & E, Chicago Heights, IL 60411 | 2008-10-28 |
| 1689827347 | Gina L Grosse | Dentist | 567 W. 14th Street, Units D and E, Chicago Heights, IL 60411 | 2008-10-28 |
| 1639320716 | Dental Experts, LLC | Dentist | 567 West 14th St., Unit D, Chicago Heights, IL 60411 | 2008-10-07 |
| 1235340373 | John R. Marinucci, D.ds., Ltd. | Dentist | 414 Dixie Hwy, Chicago Heights, IL 60411-1739 | 2007-05-24 |
| 1194939538 | Gary Edward Jagmin | Dentist | 1020 Chicago Rd, Chicago Heights, IL 60411-2600 | 2007-05-09 |
| 1316079502 | David James Storm | Dentist | 174 W Sauk Trl, Chicago Heights, IL 60411-5359 | 2007-03-12 |
| 1578642971 | Steven Shikami | Dentist | 1526 S Halsted St, Chicago Heights, IL 60411-3523 | 2006-11-04 |
| 1396759593 | Mohammad Al-asadi | Dentist | 2400 Chicago Rd, Chicago Heights, IL 60411-4160 | 2006-07-27 |
| Find all providers in CHICAGO HEIGHTS | ||||
| City | CHICAGO HEIGHTS |
| Zip Code | 60411 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.