Provider Demographics
NPI:1487798856
Name:KENNETH MANGANO, DDS PA
Entity type:Organization
Organization Name:KENNETH MANGANO, DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGNANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-766-3453
Mailing Address - Street 1:8025 RITCHIE HWY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-1031
Mailing Address - Country:US
Mailing Address - Phone:410-766-3453
Mailing Address - Fax:410-766-3454
Practice Address - Street 1:8025 RITCHIE HWY
Practice Address - Street 2:SUITE 204
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-1031
Practice Address - Country:US
Practice Address - Phone:410-766-3453
Practice Address - Fax:410-766-3454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD125841223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty