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General NPI Number Information
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NPI Number | 1275776023
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Entity Type | Individual
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Provider Name | PATRICK CHRISTOPHER MANGANELLO DMD
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Gender | Male
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Dates
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Enumeration Date | 04/09/2009
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Last Update Date | 07/07/2010
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Provider Practice Location Address
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Address Line | 126 COLLEGE AVE
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City | GREENVILLE
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State | PA
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Zip | 16125-2166
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Country | US
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Telephone | 724-301-3162
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Fax |
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Provider Business Mailing Address
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Address Line | 126 COLLEGE AVE
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City | GREENVILLE
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State | PA
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Zip | 16125-2166
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Country | US
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Telephone | 724-301-3162
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS038090
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License Number State | PA
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