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General NPI Number Information
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NPI Number | 1700565520
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Entity Type | Individual
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Provider Name | THANMAYI PANGULURI DDS
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Gender | Female
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Dates
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Enumeration Date | 07/18/2023
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 472 BROADWAY
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City | BAYONNE
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State | NJ
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Zip | 07002-7114
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Country | US
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Telephone | 201-380-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 472 BROADWAY
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City | BAYONNE
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State | NJ
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Zip | 07002-7114
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Country | US
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Telephone | 571-635-7269
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401418577
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI03075400
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License Number State | NJ
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