Provider Demographics
NPI:1962434209
Name:MANGAN, RONALD GERARD (DMD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:GERARD
Last Name:MANGAN
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 1:701 S WEST ST
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-4125
Mailing Address - Country:US
Mailing Address - Phone:717-243-9020
Mailing Address - Fax:
Practice Address - Street 1:701 S WEST ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-4125
Practice Address - Country:US
Practice Address - Phone:717-243-9020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017807L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice