MEDICARE: DR. STEPHEN JAMES MANGAN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	DN18777	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316260854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN JAMES MANGAN DMD

Provider Business Mailing Address
First Line	:	1111 SE 5TH CT
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-3005
Country	:	US
Telephone Number	:	954-655-0251
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 E LAS OLAS BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2357
Country	:	US
Telephone Number	:	954-463-5051
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2010
Last Update Date	:	03/11/2010

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