Provider Demographics
NPI:1700305711
Name:MANGLA, NEHA (DDS)
Entity type:Individual
Prefix:
First Name:NEHA
Middle Name:
Last Name:MANGLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 GARTH RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5644
Mailing Address - Country:US
Mailing Address - Phone:310-210-7890
Mailing Address - Fax:
Practice Address - Street 1:1540 PLEASANT VALLEY RD STE G
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-8760
Practice Address - Country:US
Practice Address - Phone:860-644-1095
Practice Address - Fax:860-644-1095
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT118981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice