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General NPI Number Information
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NPI Number | 1922143262
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Entity Type | Organization
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Legal Business Name | STEVE MANGAN, D.D.S., P.A.
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2011 N VAN BUREN ST
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City | LITTLE ROCK
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State | AR
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Zip | 72207-4739
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Country | US
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Telephone | 501-666-1188
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Fax | 501-666-1189
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Provider Business Mailing Address
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Address Line | 2011 N VAN BUREN ST
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City | LITTLE ROCK
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State | AR
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Zip | 72207-4739
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Country | US
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Telephone | 501-666-1188
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Fax | 501-666-1189
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Authorized Official
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Title or Position | DENTIST
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Name | MR. CHARLES STEVEN MANGAN III
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Credential | D.D.S.
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Telephone | 501-666-1188
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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 | AR2807
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License Number State | AR
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