Provider Demographics
NPI:1275776023
Name:MANGANELLO, PATRICK CHRISTOPHER (DMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:CHRISTOPHER
Last Name:MANGANELLO
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 1:126 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-2166
Mailing Address - Country:US
Mailing Address - Phone:724-301-3162
Mailing Address - Fax:
Practice Address - Street 1:126 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-2166
Practice Address - Country:US
Practice Address - Phone:724-301-3162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0380901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice