Individual
PHILIP JAMES MANGIARACINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
10033 WICKER AVE STE 9, SAINT JOHN, IN 46373-8777
(219) 365-9750
Mailing address
10033 WICKER AVE STE 9, SAINT JOHN, IN 46373-8777
(219) 365-9750
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12013086A
IN
Other
Enumeration date
07/26/2018
Last updated
10/14/2023
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