Provider Demographics
NPI:1235454430
Name:MENGELBERG, JOHN ERNEST (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ERNEST
Last Name:MENGELBERG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3313 S OSPREY AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-5916
Mailing Address - Country:US
Mailing Address - Phone:941-366-3313
Mailing Address - Fax:941-954-8500
Practice Address - Street 1:3313 S OSPREY AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-5916
Practice Address - Country:US
Practice Address - Phone:941-366-3313
Practice Address - Fax:941-954-8500
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12930122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist