MEDICARE: MR. PETER JAMES PANGILINAN DDS

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
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	10513	NC

General Provider Information

NPI Number	:	1356420186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER JAMES PANGILINAN DDS

Provider Business Mailing Address
First Line	:	9615 KINCEY AVE STE 110
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-9140
Country	:	US
Telephone Number	:	704-659-6765
Fax Number	:	304-624-0977

Provider Business Practice Location Address
First Line	:	9615 KINCEY AVE STE 110
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-9140
Country	:	US
Telephone Number	:	704-659-6765
Fax Number	:	704-659-3351

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	01/09/2024

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