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NPI Code Detail

MEDICARE: DIMPLEJIT SINGH MANGAT DDS

MEDICARE: DIMPLEJIT SINGH MANGAT DDS
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
11223G0001XGeneral Practice Dentistry1002752-15WI

General Provider Information

NPI Number : 1912650656
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIMPLEJIT SINGH MANGAT DDS
Provider Business Mailing Address
First Line : 3489 SPYGLASS HILL DR
Second Line :
City : GREEN BAY
State : WI
Zip : 54311-6116
Country : US
Telephone Number : 920-288-7238
Fax Number :
Provider Business Practice Location Address
First Line : 2280 W MASON ST
Second Line :
City : GREEN BAY
State : WI
Zip : 54303-4707
Country : US
Telephone Number : 920-321-3501
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2022
Last Update Date : 02/02/2022

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