MEDICARE: RONALD G MANGAN DMD PC

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	261QD0000X	Dental Clinic/Center	DS017807L	PA

General Provider Information

NPI Number	:	1821019530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RONALD G MANGAN DMD PC

Provider Business Mailing Address
First Line	:	701 S WEST ST STE B
Second Line	:
City	:	CARLISLE
State	:	PA
Zip	:	17013-4125
Country	:	US
Telephone Number	:	717-243-9020
Fax Number	:	717-243-8556

Provider Business Practice Location Address
First Line	:	701 S WEST ST STE B
Second Line	:
City	:	CARLISLE
State	:	PA
Zip	:	17013-4125
Country	:	US
Telephone Number	:	717-243-9020
Fax Number	:	717-243-8556

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RONALD G MANGAN
Credential	:	DMD
Telephone Number	:	717-243-9020

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	08/22/2020

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