Provider Demographics
NPI:1467829044
Name:MANGAT, SABRINA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SABRINA
Middle Name:
Last Name:MANGAT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2745 W SHAW AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3315
Mailing Address - Country:US
Mailing Address - Phone:559-227-2900
Mailing Address - Fax:559-227-6203
Practice Address - Street 1:2745 W SHAW AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3315
Practice Address - Country:US
Practice Address - Phone:559-227-2900
Practice Address - Fax:559-227-6203
Is Sole Proprietor?:No
Enumeration Date:2015-08-30
Last Update Date:2016-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA649681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice