Philip James Mangiaracina, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12013086A Issued in IN

Practice address

10033 Wicker Ave Ste 9
Saint John, IN 46373-8777

Phone

(219) 365-9750

NPI assigned

Jul 26, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• BDD of Indiana P.C.

  dba McCarroll Dental

  • Dentist
  • Saint John, IN
  • NPI 1538834064
  NPD

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

{
    "created_epoch": "1532563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697241600000",
    "number": "1316424922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10033 WICKER AVE STE 9",
            "city": "SAINT JOHN",
            "state": "IN",
            "postal_code": "463738777",
            "telephone_number": "219-365-9750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10033 WICKER AVE STE 9",
            "city": "SAINT JOHN",
            "state": "IN",
            "postal_code": "463738777",
            "telephone_number": "219-365-9750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGIARACINA",
        "first_name": "PHILIP",
        "middle_name": "JAMES",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-26",
        "last_updated": "2023-10-14",
        "certification_date": "2023-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12013086A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kalli Letz
• Nanette Lindesmith, FNP
• Steven M Lubera, DO
• James Ethan Maciejewski, DPT
• Nikhil Malik, P.T., C.E.A.S.
• Ruba Mansour
• Dorothy Maria Mason, SLP
• Norbert A Matulis, DDS
• Charles T. McCarroll, D.D.S.
• Brooke McDermott, MD

• General Practice Dentistry in Saint John, IN
• Providers in Saint John, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2023; 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.