NPIMap

Organization Active NPI

Mangelsdorf Family Dentistry

  • Dental Clinic/Center
  • Kingman, AZ
National Provider Identifier
1174707772
Registry record updated Dec 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
3751 Issued in AZ
Legal business name
MANGELSDORF FAMILY DENTISTRY
Practice address
2249 Hualapai Mountain Rd Ste a
Kingman, AZ 86401-8321
Phone
(928) 718-2136
Fax
(928) 718-2137
NPI assigned
Dec 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2007

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

Authorized official

Name
Dr. Timothy William Mangelsdorf, D.D.S.NPI 1619924669
Title
Dentist
Phone
(928) 718-2136

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 3751 AZ Primary

Addresses

Primary practice location

2249 Hualapai Mountain Rd Ste a
Kingman, AZ 86401-8321

Mailing address

2249 Hualapai Mountain Rd Ste a
Kingman, AZ 86401-8321
Phone (928) 718-2136

Other identifiers 1

IdentifierTypeStateIssuer
1619924669OtherAZNPI FOR INDIVIDUAL

National Provider Directory

National Provider Directory

Locations

2249 Hualapai Mountain Rd
Ste A
Kingman, AZ 86401
Phone (928) 718-2136

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1198022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198022400000",
    "number": "1174707772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2249 HUALAPAI MOUNTAIN RD STE A",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864018321",
            "telephone_number": "928-718-2136",
            "fax_number": "928-718-2137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2249 HUALAPAI MOUNTAIN RD STE A",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864018321",
            "telephone_number": "928-718-2136",
            "fax_number": "928-718-2137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANGELSDORF FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-19",
        "last_updated": "2007-12-19",
        "status": "A",
        "authorized_official_last_name": "MANGELSDORF",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "928-718-2136",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "AZ",
            "license": "3751",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI FOR INDIVIDUAL",
            "identifier": "1619924669",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingman, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 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.