Provider Demographics
NPI:1164492526
Name:MANGANARO, ALBERT M (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:M
Last Name:MANGANARO
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Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:HQS USA DENTAC
Mailing Address - Street 2:2817 REILLY RD
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-7302
Mailing Address - Country:US
Mailing Address - Phone:910-396-5610
Mailing Address - Fax:910-396-7017
Practice Address - Street 1:HQS USA DENTAC
Practice Address - Street 2:2817 REILLY RD
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-7302
Practice Address - Country:US
Practice Address - Phone:910-396-5610
Practice Address - Fax:910-396-7017
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2008-09-09
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Provider Licenses
StateLicense IDTaxonomies
NY36054-11223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology