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General NPI Number Information
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NPI Number | 1124720982
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Entity Type | Organization
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Legal Business Name | GANGLANI REAFIELD PLLC
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Dates
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Enumeration Date | 03/17/2023
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Last Update Date | 03/17/2023
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Provider Practice Location Address
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Address Line | 9925 REA RD STE 104
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City | WAXHAW
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State | NC
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Zip | 28173-6441
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Country | US
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Telephone | 980-500-3999
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Fax |
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Provider Business Mailing Address
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Address Line | 9925 REA RD STE 104
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City | WAXHAW
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State | NC
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Zip | 28173-6441
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Country | US
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Telephone | 980-500-3999
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | CHAD HENDRICKS
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Credential |
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Telephone | 612-859-0444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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