Provider Demographics
NPI:1659926525
Name:MANGIAFICO, KRISTINA ELIZABETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:ELIZABETH
Last Name:MANGIAFICO
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 1:1609 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-9516
Mailing Address - Country:US
Mailing Address - Phone:386-690-7630
Mailing Address - Fax:
Practice Address - Street 1:1401 S RIDGEWOOD AVE STE 6
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32132-2736
Practice Address - Country:US
Practice Address - Phone:386-426-5296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN24270122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist