Provider Demographics
NPI:1932129012
Name:MANGANARO, WILLIAM THOMAS (DMD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:THOMAS
Last Name:MANGANARO
Suffix:
Gender:M
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:BLDG-B-6837 NORMANDY DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:28310-7302
Mailing Address - Country:US
Mailing Address - Phone:910-396-2607
Mailing Address - Fax:910-396-7017
Practice Address - Street 1:BLDG-B-6837 NORMANDY DRIVE
Practice Address - Street 2:
Practice Address - City:FORT LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:28310-7302
Practice Address - Country:US
Practice Address - Phone:910-396-2607
Practice Address - Fax:910-396-7017
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-030099-L1223G0001X
NC92471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice