Yolanda Marye Mangrum, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

44612 Issued in CA

Practice address

1301 Southpoint Blvd Ste a
Petaluma, CA 94954-6858

Phone

(707) 762-0067

Fax

(707) 762-4782

NPI assigned

Mar 14, 2007

Sex

Female

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)

Enrolled

State licenses

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395619200000",
    "number": "1578697546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 SOUTHPOINT BLVD STE A",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949546858",
            "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": "1301 SOUTHPOINT BLVD STE A",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949546858",
            "telephone_number": "707-762-0067",
            "fax_number": "707-762-4782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGRUM",
        "first_name": "YOLANDA",
        "middle_name": "MARYE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-14",
        "last_updated": "2014-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "44612",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Making Magic Happen - People Helping People, Inc.
• Erika Malfavon-Alvarez
• Thomas Owen Maloney, MD
• Mario Mangiardi, MD
• Mangrum Dental Corporation
• Emily Mann, LMFT
• Elmira Manoucheri, M.D.
• Sapoora Manshaii, MD
• Stephanie Elizabeth Manulkin, FNP-BC
• Allison Marbella

• 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 Mar 24, 2014; 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.