Provider Demographics
NPI:1265661102
Name:MANGIARACINA, CONCETTA A (DDS)
Entity Type:Individual
Prefix:DR
First Name:CONCETTA
Middle Name:A
Last Name:MANGIARACINA
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 1:1780 NOBLE ST
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4019
Mailing Address - Country:US
Mailing Address - Phone:516-659-1913
Mailing Address - Fax:
Practice Address - Street 1:1780 NOBLE ST
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-4019
Practice Address - Country:US
Practice Address - Phone:516-659-1913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054974122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist