Basic Information
| Provider Information | |||||||||
| NPI: | 1164492526 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANGANARO | ||||||||
| FirstName: | ALBERT | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.D.S., M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | HQS USA DENTAC | ||||||||
| Address2: | 2817 REILLY RD | ||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283107302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103965610 | ||||||||
| FaxNumber: | 9103967017 | ||||||||
| Practice Location | |||||||||
| Address1: | HQS USA DENTAC | ||||||||
| Address2: | 2817 REILLY RD | ||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283107302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103965610 | ||||||||
| FaxNumber: | 9103967017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2006 | ||||||||
| LastUpdateDate: | 09/09/2008 | ||||||||
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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 | 1223P0106X | 36054-1 | NY | Y | Dental Providers | Dentist | Oral and Maxillofacial Pathology |
No ID Information.