Provider Demographics
NPI:1891085619
Name:MARY SCHILLING MCMANIS, DDS INC
Entity Type:Organization
Organization Name:MARY SCHILLING MCMANIS, DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:SCHILLING
Authorized Official - Last Name:MCMANIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-752-8142
Mailing Address - Street 1:11289 CLIFF ACRES DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-2413
Mailing Address - Country:US
Mailing Address - Phone:319-752-8142
Mailing Address - Fax:319-752-4756
Practice Address - Street 1:1727 DEER RUN DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-2169
Practice Address - Country:US
Practice Address - Phone:319-752-8142
Practice Address - Fax:319-752-4756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6466305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1821162371Medicaid
IA1821162371Medicaid