Basic Information
Provider Information
NPI: 1033397278
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STANGEL
FirstName: IVAN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5612 GLENWOOD RD
Address2:  
City: BETHESDA
State: MD
PostalCode: 208176728
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 60 O ST NW
Address2:  
City: WASHINGTON
State: DC
PostalCode: 200011259
CountryCode: US
TelephoneNumber: 2027978806
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/08/2008
LastUpdateDate: 02/08/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000XDEN5773DCY Dental ProvidersDentist 

No ID Information.


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