Active NPI
Luke Michael Mangelsdorf, DMD
- Dentist
- Kingman, AZ
National Provider Identifier
1447865480
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D010867
- Practice address
- 2249 Hualapai Mountain Rd Ste 1
Kingman, AZ 86401-8321 - Phone
- (928) 718-2136
- NPI assigned
- Sep 15, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D010867 | AZ | Primary |
Addresses
Primary practice location
2249 Hualapai Mountain Rd Ste 1
Kingman, AZ 86401-8321
Mailing address
2249 Hualapai Mountain Rd Ste 1
Kingman, AZ 86401-8321
Phone (928) 718-2136
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D010867 | AZ | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mangelsdorf Family Dentistry | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Dental Clinic/Center
- Kingman, AZ
- NPI 1174707772
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600128000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600128000000",
"number": "1447865480",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2249 HUALAPAI MOUNTAIN RD STE 1",
"city": "KINGMAN",
"state": "AZ",
"postal_code": "864018321",
"telephone_number": "928-718-2136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2249 HUALAPAI MOUNTAIN RD STE 1",
"city": "KINGMAN",
"state": "AZ",
"postal_code": "864018321",
"telephone_number": "928-718-2136"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANGELSDORF",
"first_name": "LUKE",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-09-15",
"last_updated": "2020-09-15",
"certification_date": "2020-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AZ",
"license": "D010867",
"primary": true
}
],
"identifiers": [],
"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 Sep 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.