Jacqueline Nelson-Mangatal, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

DN16582 Issued in FL

Practice address

3011 Central Ave
St Petersburg, FL 33713-8632

Phone

(786) 316-5044

Fax

(727) 328-1971

NPI assigned

Mar 21, 2007

Sex

Female

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

• Midtown Dental Center LLC

  • General Practice Dentistry
  • St Petersburg, FL
  • NPI 1992078521
  NPD (past) Authorized official
• Unlimited Management Group LLC

  • General Practice Dentistry
  • St Petersburg, FL
  • NPI 1396814299
  NPD (past)

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1154446649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7085 VIA LEONARDO",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334675236",
            "telephone_number": "786-316-5044",
            "fax_number": "727-328-1971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3011 CENTRAL AVE",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337138632",
            "telephone_number": "786-316-5044",
            "fax_number": "727-328-1971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON-MANGATAL",
        "first_name": "JACQUELINE",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-21",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN16582",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "075681400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebecca Lee Negron, M.D.
• Neighborly Care Network
• Neighborly Care Network
• Neighborly Care Network
• Radha Ravindra Nejak, LMFT
• Andrew A. Nelson, MD
• Aquinetta Nelson, LMHC
• Carolina Vac Nelson, M.D.
• Christopher Grant Nelson Jr., M.D.
• Claudette Nelson

• Dentist in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.