Healthcare Provider Details

I. General information

NPI: 1154837607
Provider Name (Legal Business Name): KUSH MANGAL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2017
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 NAZARETH PIKE FL 2
NAZARETH PA
18064-9615
US

IV. Provider business mailing address

2 REVERE CT
PRINCETON JUNCTION NJ
08550-2160
US

V. Phone/Fax

Practice location:
  • Phone: 610-365-5000
  • Fax:
Mailing address:
  • Phone: 609-799-5996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS042914
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: