Active NPI
Caleb Mangum
- General Practice Dentistry
- Frisco, TX
National Provider Identifier
1619454287
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 34039
- Practice address
- 4685 Eldorado Pkwy Ste 200
Frisco, TX 75033-0290 - Phone
- (214) 618-5450
- NPI assigned
- Jul 25, 2018
- Last updated
- Jul 25, 2018
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 34039 | TX | Primary |
Addresses
Primary practice location
4685 Eldorado Pkwy Ste 200
Frisco, TX 75033-0290
Mailing address
17712 River Chase Dr
Dallas, TX 75287-6265
Phone (505) 301-4473
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 |
|---|---|---|---|
| 34039 | TX | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mangum Family Dentistry PLLC | General Practice | Current | Accepting new patients |
| Jerit Davis Dental Practice | General Practice | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Practice Dentistry
- Denton, TX
- NPI 1649929449
-
- General Practice Dentistry
- Frisco, TX
- NPI 1073741070
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1532476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1532476800000",
"number": "1619454287",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17712 RIVER CHASE DR",
"city": "DALLAS",
"state": "TX",
"postal_code": "752876265",
"telephone_number": "505-301-4473"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4685 ELDORADO PKWY STE 200",
"city": "FRISCO",
"state": "TX",
"postal_code": "750330290",
"telephone_number": "214-618-5450"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANGUM",
"first_name": "CALEB",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-07-25",
"last_updated": "2018-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "34039",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Frisco, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.