Basic Information
| Provider Information | |||||||||
| NPI: | 1013062876 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANGOLD | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 BARTLETT | ||||||||
| Address2: | STE B | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155844497 | ||||||||
| FaxNumber: | 9155841031 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 BARTLETT | ||||||||
| Address2: | STE B | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155844497 | ||||||||
| FaxNumber: | 9155841031 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 08/28/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 13365 | TX | Y | Dental Providers | Dentist | General Practice |
No ID Information.