Provider Demographics
NPI:1245468495
Name:MANGINO, MATTHEW WILLIAM (DMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:WILLIAM
Last Name:MANGINO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5154 VILLAGE SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-9060
Mailing Address - Country:US
Mailing Address - Phone:270-444-6414
Mailing Address - Fax:270-444-6488
Practice Address - Street 1:8944 COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-1121
Practice Address - Country:US
Practice Address - Phone:513-774-8800
Practice Address - Fax:513-774-5314
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY91151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice