Provider Demographics
NPI:1003882333
Name:MANGIE, CRAIG FRANCIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:FRANCIS
Last Name:MANGIE
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 1:9500 EUCLID AVE # DESKA71
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-4802
Mailing Address - Fax:216-445-8570
Practice Address - Street 1:9500 EUCLID AVE # DESKA71
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-4501
Practice Address - Country:US
Practice Address - Phone:216-444-4802
Practice Address - Fax:216-445-8570
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH164521223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMA0774901Medicare ID - Type Unspecified
WV2792AMedicare Oscar/Certification
OHT48104Medicare UPIN