Healthcare Provider Details

I. General information

NPI: 1902882582
Provider Name (Legal Business Name): GREGORY JOSEPH GANGI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BHC ATSUGI PSC 477 BOX 2
FPO AP
96306
JP

IV. Provider business mailing address

BHC ATSUGI PSC 477 BOX 2
FPO AP
96306
JP

V. Phone/Fax

Practice location:
  • Phone: 2643612
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number051629
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: