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General NPI Number Information
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NPI Number | 1164033627
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Entity Type | Organization
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Legal Business Name | GANGLANI DMD PLLC
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Dates
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Enumeration Date | 08/10/2020
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Last Update Date | 08/10/2020
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Provider Practice Location Address
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Address Line | 9816 SAM FURR RD
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-4946
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Country | US
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Telephone | 704-997-5110
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Fax |
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Provider Business Mailing Address
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Address Line | 9816 SAM FURR RD
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-4946
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Country | US
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Telephone | 704-997-5110
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF IMPLEMENTATION
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Name | RICHARD B VELAZQUE
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Credential |
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Telephone | 704-218-2132
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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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