Provider Demographics
NPI:1194746875
Name:MANGANO, BRIAN K (DMD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:K
Last Name:MANGANO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:487 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844
Mailing Address - Country:US
Mailing Address - Phone:978-682-6071
Mailing Address - Fax:978-557-0022
Practice Address - Street 1:487 BROADWAY
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-2024
Practice Address - Country:US
Practice Address - Phone:978-682-6071
Practice Address - Fax:978-557-0022
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA161851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice