St Louis Dental Implant Group

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

ST LOUIS DENTAL IMPLANT GROUP

Practice address

3750 Green Mount Crossing Dr
Shiloh, IL 62269

Phone

(314) 729-7840

NPI assigned

Apr 18, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Mark Alan Mangels, DMD

Title

Owner

Phone

(636) 970-0295

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1208476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208476800000",
    "number": "1447424668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11222 TESSON FERRY RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631236963",
            "telephone_number": "314-729-7840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3750 GREEN MOUNT CROSSING DR",
            "city": "SHILOH",
            "state": "IL",
            "postal_code": "62269",
            "telephone_number": "314-729-7840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LOUIS DENTAL IMPLANT GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-18",
        "last_updated": "2008-04-18",
        "status": "A",
        "authorized_official_last_name": "MANGELS",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "636-970-0295",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Polly Bhattacharyya Sinha, P.T.
• Swastik Kumar Sinha, M.D.
• Matthew R Smith, DO
• Misty Dawn Smith, NP
• SNH Lincoln Tenant LLC
• Haley St Peters, CNM
• St. Louis JC Vamc
• Holly Laura Steiner, MD
• Dustin Storck, D.P.T.
• Kyla Gelina Sulcer, PTA

• Dentist in Shiloh, IL
• Providers in Shiloh, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 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.