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General NPI Number Information
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NPI Number | 1700952587
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Entity Type | Organization
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Legal Business Name | RICHARD MANGUM DDS PC
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Dates
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Enumeration Date | 11/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1767 WILLOW CREEK RD
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City | PRESCOTT
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State | AZ
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Zip | 86301-1154
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Country | US
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Telephone | 928-778-4110
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Fax | 928-778-4114
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Provider Business Mailing Address
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Address Line | 1767 WILLOW CREEK RD
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City | PRESCOTT
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State | AZ
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Zip | 86301-1154
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Country | US
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Telephone | 928-778-4110
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Fax | 928-778-4114
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD TURNER MANGUM
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Credential | D.D.S.
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Telephone | 928-778-4110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1904
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License Number State | AZ
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