Mangrum Dental Corporation

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

44612 Issued in CA

Legal business name

MANGRUM DENTAL CORPORATION

Doing business as

Petaluma Dental Group

Practice address

1430 E Washington St
Petaluma, CA 94954-3631

Phone

(707) 762-0067

Fax

(707) 762-4782

NPI assigned

Apr 15, 2009

Organization subpart

No

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

Authorized official

Name

Mr. Debra A Quackenbush

Title

Office Manager

Phone

(707) 762-0067

Specialties & licenses 1

Addresses

Other names 1

• Petaluma Dental Group Doing business as

Locations

Practitioners 3

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

• Heather Yvadne Anderson, D.D.S.

  • General Practice Dentistry
  • Santa Rosa, CA
  • NPI 1780971838
  NPD (past)
• Thomas Vincent Dembski, DDS

  • Dentist
  • Petaluma, CA
  • NPI 1023026911
  NPD (past)
• Richard Korman, DDS

  • General Practice Dentistry
  • Petaluma, CA
  • NPI 1912008483
  NPD (past)

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

{
    "created_epoch": "1239753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239753600000",
    "number": "1275776684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 E WASHINGTON ST",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949543631",
            "telephone_number": "707-762-0067",
            "fax_number": "707-762-4782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 E WASHINGTON ST",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949543631",
            "telephone_number": "707-762-0067",
            "fax_number": "707-762-4782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANGRUM DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-15",
        "last_updated": "2009-04-15",
        "status": "A",
        "authorized_official_last_name": "QUACKENBUSH",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "707-762-0067",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "44612",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Petaluma Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Aziz Majid
• Making Magic Happen - People Helping People, Inc.
• Erika Malfavon-Alvarez
• Thomas Owen Maloney, MD
• Mario Mangiardi, MD
• Yolanda Marye Mangrum, D.D.S.
• Emily Mann, LMFT
• Elmira Manoucheri, M.D.
• Sapoora Manshaii, MD
• Stephanie Elizabeth Manulkin, FNP-BC

• General Practice Dentistry in Petaluma, CA
• Providers in Petaluma, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2009; 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.