Charles Steven Mangan III, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

AR2807 Issued in AR

Practice address

2011 N Van Buren St
Little Rock, AR 72207-4739

Phone

(501) 666-1188

Fax

(501) 666-1189

NPI assigned

Feb 21, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 13, 2016 through Apr 13, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Steve Mangan, D.D.S., P.a.

  • General Practice Dentistry
  • Little Rock, AR
  • NPI 1922143262
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1144365446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2011 N VAN BUREN ST",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722074739",
            "telephone_number": "501-666-1188",
            "fax_number": "501-666-1189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2011 N VAN BUREN ST",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722074739",
            "telephone_number": "501-666-1188",
            "fax_number": "501-666-1189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGAN",
        "first_name": "CHARLES",
        "middle_name": "STEVEN",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": "AR2807",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "662941",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "58242",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Mancino, MD
• Rajendra Mandalapu, MD
• Victor L Mandoff, MD
• Ann W Maners, MD
• Andrew Reynolds Mangan
• Matthew David Mangan
• Sarah Mangham
• John Mangiaracina, PHD
• Rylie Mangold
• Jordan L Mangum

• General Practice Dentistry in Little Rock, AR
• Providers in Little Rock, AR by specialty
• General Practice Dentistry in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.