Provider Demographics
NPI:1972224897
Name:MANGAL, JAYA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAYA
Middle Name:
Last Name:MANGAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 MEDICAL PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3241
Mailing Address - Country:US
Mailing Address - Phone:281-296-6797
Mailing Address - Fax:
Practice Address - Street 1:1001 MEDICAL PLAZA DR STE 200
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3257
Practice Address - Country:US
Practice Address - Phone:848-218-8836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice