Provider Demographics
NPI:1326633314
Name:MANGUI, GIBRAN SAID (DMD)
Entity Type:Individual
Prefix:DR
First Name:GIBRAN
Middle Name:SAID
Last Name:MANGUI
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 1:25 JAN KARSKI WAY APT 630
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02125-2875
Mailing Address - Country:US
Mailing Address - Phone:301-325-5805
Mailing Address - Fax:
Practice Address - Street 1:625 ELMWOOD AVENUE, BOX#683
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620
Practice Address - Country:US
Practice Address - Phone:585-275-5051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program