Provider Demographics
NPI:1497493142
Name:MANGELSON, ERIK LEGRAND (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:LEGRAND
Last Name:MANGELSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51300 POMERANTZ FAMILY PAVILION
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1049
Mailing Address - Country:US
Mailing Address - Phone:193-356-2205
Mailing Address - Fax:319-335-8956
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-7339
Practice Address - Fax:319-353-6923
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IARES-306301223S0112X, 204E00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery