Provider Demographics
NPI:1497700991
Name:MANCZAK, NEIL C (DDS)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:C
Last Name:MANCZAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27731 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081
Mailing Address - Country:US
Mailing Address - Phone:586-771-3440
Mailing Address - Fax:586-771-8877
Practice Address - Street 1:6250 S CEDAR ST
Practice Address - Street 2:STE. 5
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-5744
Practice Address - Country:US
Practice Address - Phone:517-394-2226
Practice Address - Fax:517-394-3860
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010192411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice