MEDICARE: DR. ALBERT M MANGANARO D.D.S., M.S.

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	1223P0106X	Oral and Maxillofacial Pathology Dentistry	36054-1	NY

General Provider Information

NPI Number	:	1164492526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALBERT M MANGANARO D.D.S., M.S.

Provider Business Mailing Address
First Line	:	HQS USA DENTAC
Second Line	:	2817 REILLY RD
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-7302
Country	:	US
Telephone Number	:	910-396-5610
Fax Number	:	910-396-7017

Provider Business Practice Location Address
First Line	:	HQS USA DENTAC
Second Line	:	2817 REILLY RD
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-7302
Country	:	US
Telephone Number	:	910-396-5610
Fax Number	:	910-396-7017

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	09/09/2008

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