MEDICARE: DR. DAVID J MANEGOLD DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30022514	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1710333869	OTHER		GROUP NPI
2	1730999194	OTHER		GROUP NPI

General Provider Information

NPI Number	:	1134321375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID J MANEGOLD DMD

Provider Business Mailing Address
First Line	:	9215 CINCINNATI COLUMBUS RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45069
Country	:	US
Telephone Number	:	513-777-5513
Fax Number	:

Provider Business Practice Location Address
First Line	:	9215 CINCINNATI COLUMBUS RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45069
Country	:	US
Telephone Number	:	513-777-5513
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	01/09/2025

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