Kelly A Mangrum, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2663 Issued in UT

Practice address

7110 Highland Dr
Cottonwood Heights, UT 84121-3704

Phone

(801) 943-6880

Fax

(801) 943-4744

NPI assigned

Aug 19, 2008

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1219104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219104000000",
    "number": "1396992699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7L110 SOUTH HIGHLAND DRIVE",
            "city": "COTTONWOOD HEIGHTS",
            "state": "UT",
            "postal_code": "84121",
            "telephone_number": "801-943-6880",
            "fax_number": "801-943-4744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7110 HIGHLAND DR",
            "city": "COTTONWOOD HEIGHTS",
            "state": "UT",
            "postal_code": "841213704",
            "telephone_number": "801-943-6880",
            "fax_number": "801-943-4744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGRUM",
        "first_name": "KELLY",
        "middle_name": "A",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-19",
        "last_updated": "2008-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "2663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtnee Nadine Malan, MD
• Shawna Lee Malcolm, L.P.C.
• Taylor Malmborg
• Dallin Blaine Mandel
• Jecely Manfoste
• Dave Mangum, CMHC
• Ashley Jane Mann
• Jessica Xaiz Mann, LCSW
• Benjamin James Marden
• Mark R Johnson MD PC

• General Practice Dentistry in Cottonwood Heights, UT
• Providers in Cottonwood Heights, UT by specialty
• General Practice Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2008; 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.