Provider Demographics
NPI:1235175514
Name:MANGAL, ANU (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANU
Middle Name:
Last Name:MANGAL
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 1:4151 17 MILE RD STE F
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-6866
Mailing Address - Country:US
Mailing Address - Phone:586-979-3200
Mailing Address - Fax:586-979-3226
Practice Address - Street 1:4151 17 MILE RD STE F
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-6866
Practice Address - Country:US
Practice Address - Phone:586-979-3200
Practice Address - Fax:586-979-3226
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010172611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice