Healthcare Provider Details

I. General information

NPI: 1497493142
Provider Name (Legal Business Name): ERIK LEGRAND MANGELSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 S 32ND ST W STE B
BILLINGS MT
59102-6875
US

IV. Provider business mailing address

152 S 32ND ST W STE B
BILLINGS MT
59102-6875
US

V. Phone/Fax

Practice location:
  • Phone: 406-655-0170
  • Fax: 406-655-2271
Mailing address:
  • Phone: 406-655-0170
  • Fax: 406-655-2271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDEN-DEN-LIC-33232
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDEN-DEN-LIC-33232
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number1719
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: