Provider Demographics
NPI:1659451771
Name:MENGEL, DAVID M (CPD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:M
Last Name:MENGEL
Suffix:
Gender:M
Credentials:CPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGTOWN
Mailing Address - State:AZ
Mailing Address - Zip Code:85363-1017
Mailing Address - Country:US
Mailing Address - Phone:623-974-5629
Mailing Address - Fax:623-974-1770
Practice Address - Street 1:11100 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:YOUNGTOWN
Practice Address - State:AZ
Practice Address - Zip Code:85363-1017
Practice Address - Country:US
Practice Address - Phone:623-974-5629
Practice Address - Fax:623-974-1770
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ015122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist