Provider Demographics
NPI:1720346893
Name:MANGUAL RIVERA, ANGIE MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:ANGIE
Middle Name:MARIE
Last Name:MANGUAL RIVERA
Suffix:
Gender:F
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:GALERIA PROFESIONAL 8118 SUITE 208
Mailing Address - Street 2:CALLE CONCORDIA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717
Mailing Address - Country:US
Mailing Address - Phone:787-246-4062
Mailing Address - Fax:
Practice Address - Street 1:GALERIA PROFESIONAL 8118 SUITE 208
Practice Address - Street 2:CALLE CONCORDIA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-246-4062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR31911223G0001X
PR4888477390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223G0001XDental ProvidersDentistGeneral Practice