Healthcare Provider Details

I. General information

NPI: 1659451771
Provider Name (Legal Business Name): DAVID M MENGEL C.P.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 W MICHIGAN AVE
YOUNGTOWN AZ
85363-1017
US

IV. Provider business mailing address

11100 W MICHIGAN AVE
YOUNGTOWN AZ
85363-1017
US

V. Phone/Fax

Practice location:
  • Phone: 623-974-5629
  • Fax: 623-974-1770
Mailing address:
  • Phone: 623-974-5629
  • Fax: 623-974-1770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number015
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: