DR. RICHARD J. MANTOAN (NPI# 1740283605) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740283605 |
| Entity Type | Individual |
| Full Name | DR. RICHARD J. MANTOAN |
| Credential | DDS |
| Practice Address |
19815 Governors Hwy Ste 7 Flossmoor IL 60422-4388 |
| Practice Telephone | 7087997800 |
| Practice Fax Number | 7087994864 |
| Mailing Telephone | 7087997800 |
| Mailing Fax Number | 7087994864 |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2007-07-08 |
| NPI Deactivation Date | 03/16/2006 |
| NPI Reactivation Date | 2006-03-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
19A15308 | IL | Dental Providers |
| Street Address |
19815 GOVERNORS HWY STE 7 |
| City | FLOSSMOOR |
| State | IL |
| Zip Code | 60422-4388 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164820544 | Generand Carandang Algenio | Dentist | 19815 Governors Hwy, Suite 4, Flossmoor, IL 60422-4385 | 2014-12-16 |
| 1376756791 | Dennis John Mcfarland | Physician Assistant | 19815 Governors Hwy, Suite 2, Flossmoor, IL 60422-4385 | 2007-05-08 |
| 1194945667 | Rebecca J. Testa | Dentist | 19815 Governors Hwy, Suite # 4, Flossmoor, IL 60422-4385 | 2007-04-26 |
| 1336288695 | Southland Smiles, Ltd | Dentist | 19815 Governors Hwy, Suite 7, Flossmoor, IL 60422-4385 | 2007-02-05 |
| 1992863500 | Pediatric Dental Specialty Associates Ltd | Dentist | 19815 Governors Hwy, Suite 4, Flossmoor, IL 60422 | 2006-12-05 |
| 1093719908 | Robert Jay Hart | Allergy & Immunology | 19815 Governors Hwy, Suite 2, Flossmoor, IL 60422-4385 | 2005-06-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588274310 | Miranda Home Health Care Inc | Nursing Care | 19150 S. Kedzie Ave, 203, Flossmoor, IL 60422 | 2020-08-06 |
| 1285256172 | Bp Behavioral Services, LLC | Behavioral Analyst | 2222 Marston Lane, Flossmoor, IL 60422 | 2020-05-13 |
| 1891164133 | Lauren Simpson | Behavioral Analyst | 19530 Kezie Avenue, Flossmoor, IL 60422 | 2015-09-16 |
| 1437541190 | Keshawn Gardner | Specialist/Technologist, Other | 1248 Berry Ln, Flossmoor, IL 60422 | 2015-03-04 |
| 1770989717 | Naomi Kelly | Behavioral Analyst | 1930 Kedzie Avenue, Flossmoor, IL 60422 | 2014-11-18 |
| 1093059453 | Miranda Home Health Care Inc | In Home Supportive Care | 19150 S Kedzie Ave, 203, Flossmoor, IL 60422 | 2012-11-23 |
| 1285981506 | Restorative Life Services, LLC | Social Worker | 169624 Governors Highway, Flossmoor, IL 60422 | 2012-08-06 |
| 1063786457 | Gwyneeda Carter-sidberry | Pharmacist | 1443 Selkirk Street, Flossmoor, IL 60422 | 2012-03-02 |
| 1053682021 | Alfonso Javier Medina Sr. | Anesthesiology | 3141 Stonegate Ct., Flossmoor, IL 60422 | 2012-01-23 |
| 1912121161 | Anthony J Maoloni | Dentist | 19815 Governors Highway, Orthodontic Associates Ltd Suite 1, Flossmoor, IL 60422 | 2007-04-12 |
| Find all providers in zip 60422 | ||||
| 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 |
|---|---|---|---|---|
| 1568991040 | Ni Van | Dentist | 19815 Governors Hwy Ste 7, Flossmoor, IL 60422-4388 | 2017-06-08 |
| 1023211844 | Stephen Edward Jarvie | Dentist | 19509 Governors Hwy, Flossmoor, IL 60422-2097 | 2007-06-08 |
| 1639383060 | Avery C. Powell | Dentist | 1719 Heather Hill Cres, Flossmoor, IL 60422-2041 | 2007-05-08 |
| 1982829255 | Daniel William Daly | Dentist | 1835 Dixie Hwy, Flossmoor, IL 60422-1974 | 2007-04-13 |
| 1740341973 | Charles J Greenebaum | Dentist | 19615 Governors Hwy, Flossmoor, IL 60422-2037 | 2006-12-12 |
| 1194811885 | Judy Ann Johnson, Dds, PC | Dentist | 1030 Sterling Avenue, Flossmoor, IL 60422-1265 | 2006-10-04 |
| 1245258318 | Kevin Lloyd Fatland | Dentist | 19509 Governor's Highway, Flossmoor, IL 60422-2097 | 2006-07-17 |
| 1508366717 | Matthew Mark Witkowski | Dentist | 19615 Governors Hwy, Flossmoor, IL 60422-2037 | 2018-02-14 |
| 1326457169 | Atdental LLC | Dentist | 19730 Governors Hwy, Suite 1, Flossmoor, IL 60422 | 2014-08-06 |
| 1598063885 | R.a. Berquist, D.d.s., P.C. | Dentist | 19710 Governors Hwy, Suite #4, Flossmoor, IL 60422-2080 | 2011-03-10 |
| Find all providers in FLOSSMOOR | ||||
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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.