Provider Demographics
NPI:1124428347
Name:MNM DENTAL GROUP
Entity type:Organization
Organization Name:MNM DENTAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANGINI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-281-9411
Mailing Address - Street 1:355 5TH AVE STE 1520
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-2418
Mailing Address - Country:US
Mailing Address - Phone:412-281-9411
Mailing Address - Fax:
Practice Address - Street 1:355 5TH AVE STE 1520
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-2418
Practice Address - Country:US
Practice Address - Phone:412-281-9411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0383951223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty