Provider Demographics
NPI:1093813115
Name:MANGAPIT, RONRICO ARCANGEL (DMD, PC)
Entity Type:Individual
Prefix:MR
First Name:RONRICO
Middle Name:ARCANGEL
Last Name:MANGAPIT
Suffix:
Gender:M
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S MARYLAND PKWY
Mailing Address - Street 2:SUITE A PARKWAY DENTAL
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-5319
Mailing Address - Country:US
Mailing Address - Phone:702-384-3461
Mailing Address - Fax:702-384-2377
Practice Address - Street 1:210 S MARYLAND PARKWAY
Practice Address - Street 2:SUITE A PARKWAY DENTAL
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-5319
Practice Address - Country:US
Practice Address - Phone:702-384-3461
Practice Address - Fax:702-384-2377
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV41561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100510354Medicaid