Ronald Richard Manglaviti, D.M.D.
Individual provider Active NPI Dentist · Lake Winola, PA
NPI 1760513360 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1760513360
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DS030229L (PA)
- Practice address
- Route 307
Lake Winola, PA 18625-0335 - Phone
- (570) 378-3305
- Fax
- (570) 378-3430
- NPI assigned
- Mar 8, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS030229L | PA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS030229L | PA | Yes |
Addresses
Primary practice location
Route 307
Lake Winola, PA 18625-0335
Mailing address
PO Box 335
Lake Winola, PA 18625-0335
Phone (570) 378-3305
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 980879 | Other | PA | UNITED CONCORDIA |
Other providers in Lake Winola, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.