Mark Legrand Mangelson, DDS, MS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

1439699922 Issued in UT

Practice address

4010 S 700 E Ste 8
Salt Lake City, UT 84107-2573

Phone

(801) 266-3519

NPI assigned

Feb 1, 2007

Sex

Male

Sole proprietor

Yes

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)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: mmangelson297048@direct.med.utah.edu

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.

• Salt Lake Implants and Periodontics

  • Periodontics
  • Salt Lake City, UT
  • NPI 1922664556
  NPD (past) Authorized official

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1851439251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4010 S 700 E STE 8",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841072573",
            "telephone_number": "801-266-3519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4010 S 700 E STE 8",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841072573",
            "telephone_number": "801-266-3519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGELSON",
        "first_name": "MARK",
        "middle_name": "LEGRAND",
        "credential": "DDS, MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "UT",
            "license": "1439699922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mandala Healing Journeys
• Phyllis Karen Mandel, MD
• Angela Marie Mandeville, CSW
• Martha P Mandujano, PA-C
• William Andrew Mangan
• Michael W. Mangelson, M.D.
• Mindy Gene Mangelson, CSUDC
• Ned Legrande Mangelson, M.D.
• Maile Mangisi
• Allison Mangrum, DPT

• Periodontics in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Periodontics in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.