Provider Demographics
NPI:1447950100
Name:DENTAL HAUSE PLLC
Entity type:Organization
Organization Name:DENTAL HAUSE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCINI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MBA
Authorized Official - Phone:872-710-3666
Mailing Address - Street 1:3666 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-4132
Mailing Address - Country:US
Mailing Address - Phone:872-710-3666
Mailing Address - Fax:
Practice Address - Street 1:3666 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-4132
Practice Address - Country:US
Practice Address - Phone:872-710-3666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental