Organization
J. BRETT MANGUM DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH BRETT MANGUM DDS (PRESIDENT)
(928) 778-4110
Entity
Organization
Contact information
Practice address
1767 WILLOW CREEK RD, PRESCOTT, AZ 86301-1154
(928) 778-4110
(928) 778-4114
Mailing address
1767 WILLOW CREEK RD, PRESCOTT, AZ 86301-1154
(928) 778-4110
(928) 778-4114
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D5563
AZ
Other
Enumeration date
11/14/2006
Last updated
08/22/2020
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