Individual
MARK LEGRAND MANGELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
4010 S 700 E STE 8, SALT LAKE CITY, UT 84107-2573
(801) 266-3519
Mailing address
4010 S 700 E STE 8, SALT LAKE CITY, UT 84107-2573
(801) 266-3519
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
1439699922
UT
Other
Enumeration date
02/01/2007
Last updated
07/08/2007
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