Provider Demographics
NPI:1447431333
Name:MAPANAO, MIGNON C (DDS)
Entity type:Individual
Prefix:DR
First Name:MIGNON
Middle Name:C
Last Name:MAPANAO
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 1:5752 LONETREE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-3734
Mailing Address - Country:US
Mailing Address - Phone:916-469-3613
Mailing Address - Fax:888-426-7339
Practice Address - Street 1:5752 LONETREE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-3734
Practice Address - Country:US
Practice Address - Phone:916-469-3613
Practice Address - Fax:888-426-7339
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55740122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD55740Medicaid