Provider Demographics
NPI:1518158252
Name:MANGUAL, DONALD (DMD,MSD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:MANGUAL
Suffix:
Gender:M
Credentials:DMD,MSD
Other - Prefix:DR
Other - First Name:DONALD
Other - Middle Name:
Other - Last Name:MANGUAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD,MSD
Mailing Address - Street 1:400 AVE FD ROOSEVELT STE 407
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2163
Mailing Address - Country:US
Mailing Address - Phone:787-946-5556
Mailing Address - Fax:
Practice Address - Street 1:400 AVE FD ROOSEVELT
Practice Address - Street 2:OFF. 512
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2103
Practice Address - Country:US
Practice Address - Phone:787-756-6380
Practice Address - Fax:787-756-6381
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8011223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR039086300Medicaid