Provider Demographics
NPI:1851465769
Name:MASANGKAY, MENCITA DABU (DMD)
Entity Type:Individual
Prefix:
First Name:MENCITA
Middle Name:DABU
Last Name:MASANGKAY
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 1:500 ALFRED NOBEL DR STE 145
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1839
Mailing Address - Country:US
Mailing Address - Phone:510-741-7788
Mailing Address - Fax:510-741-7705
Practice Address - Street 1:500 ALFRED NOBEL DR STE 145
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-1839
Practice Address - Country:US
Practice Address - Phone:510-741-7788
Practice Address - Fax:510-741-7705
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA440281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice