Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 16452 | OH |
NPI | 1003882333 |
---|---|
Provider Name | Dr. Craig Francis Mangie |
First Address | Cleveland, OH 44195-0001 |
Second Address | Cleveland, OH 44195-4501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 10/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T48104 | (02) | OH |