Provider Demographics
NPI:1366809865
Name:MANGASI, MARICRIS (DDS)
Entity type:Individual
Prefix:DR
First Name:MARICRIS
Middle Name:
Last Name:MANGASI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 HUALANI ST
Mailing Address - Street 2:BLDG 9 SUITE 192
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4378
Mailing Address - Country:US
Mailing Address - Phone:808-935-6620
Mailing Address - Fax:
Practice Address - Street 1:400 HUALANI ST
Practice Address - Street 2:BLDG 9 STE 192
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4378
Practice Address - Country:US
Practice Address - Phone:808-935-6620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-26391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice