Provider Demographics
NPI:1457764458
Name:MANGUM, JANET E (DMD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:E
Last Name:MANGUM
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 1:7201 LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-9232
Mailing Address - Country:US
Mailing Address - Phone:704-545-3363
Mailing Address - Fax:704-545-0446
Practice Address - Street 1:7201 LEBANON RD
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-9232
Practice Address - Country:US
Practice Address - Phone:704-545-3363
Practice Address - Fax:704-545-0446
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC99791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice