Provider Demographics
NPI:1366528978
Name:MANGAPIT, ROMAN C JR (DMD)
Entity type:Individual
Prefix:DR
First Name:ROMAN
Middle Name:C
Last Name:MANGAPIT
Suffix:JR
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 1:750 WILLARD ST
Mailing Address - Street 2:6B
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7418
Mailing Address - Country:US
Mailing Address - Phone:508-996-3360
Mailing Address - Fax:
Practice Address - Street 1:172 N DARTMOUTH MALL
Practice Address - Street 2:
Practice Address - City:N DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-4204
Practice Address - Country:US
Practice Address - Phone:508-996-3360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA191121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice