Individual
MR. CHARLES STEVEN MANGAN III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2011 N VAN BUREN ST, LITTLE ROCK, AR 72207-4739
(501) 666-1188
(501) 666-1189
Mailing address
2011 N VAN BUREN ST, LITTLE ROCK, AR 72207-4739
(501) 666-1188
(501) 666-1189
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
AR2807
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
58242
BLUE CROSS BLUE SHIELD
AR
01
—
662941
UNITED CONCORDIA
AR
Enumeration date
02/21/2007
Last updated
07/08/2007
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