Patrick Procopio Yanong Mangan, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN1858009 Issued in MA

Practice address

One Main St
Peabody, MA 01960

Phone

(978) 532-2700

NPI assigned

Jun 15, 2018

Sex

Male

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• 42 North Dental Care, LLC

  • Dental Clinic/Center
  • Peabody, MA
  • NPI 1124397989
  NPD (past)
• Great Hill Dental Partners, LLC

  • Dentist
  • Peabody, MA
  • NPI 1245517176
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 5, 2018.

{
    "created_epoch": "1529020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530748800000",
    "number": "1013401876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2937 WEALD ST",
            "city": "WHITELAND",
            "state": "IN",
            "postal_code": "461849255",
            "telephone_number": "312-998-0104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ONE MAIN ST",
            "city": "PEABODY",
            "state": "MA",
            "postal_code": "01960",
            "telephone_number": "978-532-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGAN",
        "first_name": "PATRICK",
        "middle_name": "PROCOPIO YANONG",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-15",
        "last_updated": "2018-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "DN1858009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Milton Mancialemus
• Mark Joseph Mancinelli, D.C.
• Carolyn Natalie Mancini, FNP
• Catherine Mandeville, MSW
• Dimitra A Manesis, M.D.
• Nicholas Michael Manos
• Leigh Ann Mansberger, MD
• Marsha Marcelin
• Jose Marchena, DMD,MD
• Jacquelyn Kathleen Marchetti

• All providers in Peabody, MA
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.