Individual
PRIYAL P MANGROLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
810 S WAUKEGAN RD STE 101, LAKE FOREST, IL 60045-2672
(847) 615-5437
Mailing address
9727 KEELER AVE, SKOKIE, IL 60076-1129
(281) 889-7688
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2017021966
MO
1223P0221X
Pediatric Dentistry
Primary
021003078
IL
Other
Enumeration date
06/30/2017
Last updated
09/18/2024
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