Active NPI
Kristina Elizabeth Mangiafico, DMD
- Dentist
- Edgewater, FL
National Provider Identifier
1659926525
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN24270
- Practice address
- 1401 S Ridgewood Ave Ste 6
Edgewater, FL 32132-2736 - Phone
- (386) 426-5296
- NPI assigned
- Aug 7, 2019
- Last updated
- Aug 7, 2019
- Sex
- Female
- 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 | DN24270 | FL | Primary |
Addresses
Primary practice location
1401 S Ridgewood Ave Ste 6
Edgewater, FL 32132-2736
Mailing address
1609 James St
New Smyrna Beach, FL 32168-9516
Phone (386) 690-7630
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Sep 28, 2023 through Sep 28, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN24270 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1565136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565136000000",
"number": "1659926525",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1609 JAMES ST",
"city": "NEW SMYRNA BEACH",
"state": "FL",
"postal_code": "321689516",
"telephone_number": "386-690-7630"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1401 S RIDGEWOOD AVE STE 6",
"city": "EDGEWATER",
"state": "FL",
"postal_code": "321322736",
"telephone_number": "386-426-5296"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANGIAFICO",
"first_name": "KRISTINA",
"middle_name": "ELIZABETH",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-07",
"last_updated": "2019-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN24270",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edgewater, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.