=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780715714
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID G. NANGLE DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2007
-----------------------------------------------------
Last Update Date | 11/26/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 MCINTOSH DR.
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13021-1246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-253-4902
-----------------------------------------------------
Fax | 315-253-4902
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 MCINTOSH DR.
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13021-9495
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-685-1914
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 038541
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------