Provider Demographics
NPI:1023564671
Name:MANASOVSKA, NATASA (DMD)
Entity Type:Individual
Prefix:
First Name:NATASA
Middle Name:
Last Name:MANASOVSKA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6111 KNOLL WOOD RD APT 103
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-2030
Mailing Address - Country:US
Mailing Address - Phone:708-299-3221
Mailing Address - Fax:
Practice Address - Street 1:6111 KNOLLWOOD RD
Practice Address - Street 2:APT. 103
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527
Practice Address - Country:US
Practice Address - Phone:708-268-0211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.030745122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist