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NPI Code Detail

MEDICARE: GANGLANI DMD PLLC

MEDICARE: GANGLANI DMD PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1346851805
Entity Type Code : Organization
Provider Name (Legal Business Name) : GANGLANI DMD PLLC
Provider Business Mailing Address
First Line : 8420 PARK RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28210-5801
Country : US
Telephone Number : 704-910-3098
Fax Number :
Provider Business Practice Location Address
First Line : 8420 PARK RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28210-5801
Country : US
Telephone Number : 704-910-3098
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF IMPLEMENTATION
Name : RICHARD B VELAZQUE
Credential :
Telephone Number : 704-218-2132
Provider Enumeration Date : 08/10/2020
Last Update Date : 08/10/2020

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