=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417364605
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOSE CANGAS DDS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2014
-----------------------------------------------------
Last Update Date | 07/19/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10564 S US HIGHWAY 15 501 STE E
-----------------------------------------------------
City | SOUTHERN PINES
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28387-5166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-830-9332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10564 S US HIGHWAY 15 501 STE E
-----------------------------------------------------
City | SOUTHERN PINES
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28387-5166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-830-9332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOSE ALBERTO CANGAS
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 214-830-9332
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 9374
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------