Provider Demographics
NPI:1124132279
Name:GRANNAN-MANCHEN, VICTORIA K (DDS)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:K
Last Name:GRANNAN-MANCHEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 W BUTTERFIELD RD
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5069
Mailing Address - Country:US
Mailing Address - Phone:630-834-4116
Mailing Address - Fax:630-834-4114
Practice Address - Street 1:340 W BUTTERFIELD RD
Practice Address - Street 2:SUITE 1D
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5069
Practice Address - Country:US
Practice Address - Phone:630-834-4116
Practice Address - Fax:630-834-4114
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190233181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice