Provider Demographics
NPI:1114945904
Name:MANGIN, JOHN A (D M D)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:MANGIN
Suffix:
Gender:M
Credentials:D M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 BEAVER GRADE RD
Mailing Address - Street 2:
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2766
Mailing Address - Country:US
Mailing Address - Phone:412-262-3190
Mailing Address - Fax:412-262-3966
Practice Address - Street 1:995 BEAVER GRADE RD
Practice Address - Street 2:
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108-2766
Practice Address - Country:US
Practice Address - Phone:412-262-3190
Practice Address - Fax:412-262-3966
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019549L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice