MEDICARE: GANGLANI TRIANGLE OF DURHAM PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1912761495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GANGLANI TRIANGLE OF DURHAM PLLC

Provider Business Mailing Address
First Line	:	1920 E NC HIGHWAY 54 STE 410
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-2262
Country	:	US
Telephone Number	:	919-544-8106
Fax Number	:

Provider Business Practice Location Address
First Line	:	1920 E NC HIGHWAY 54 STE 410
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-2262
Country	:	US
Telephone Number	:	919-544-8106
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	CHAD HENDRICKS
Credential	:
Telephone Number	:	612-859-0444

Provider Enumeration Date	:	02/06/2024
Last Update Date	:	02/06/2024

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