MEDICARE: DR. RICHARD VANGURP, DDS 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
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1407337801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. RICHARD VANGURP, DDS PLLC

Provider Business Mailing Address
First Line	:	3111 SPRINGBANK LN STE F
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-3373
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3111 SPRINGBANK LN STE F
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-3373
Country	:	US
Telephone Number	:	704-542-2884
Fax Number	:

Authorized Official
Title or Position	:	DDS
Name	:	RICHARD VANGURP
Credential	:	DDS
Telephone Number	:	931-446-8045

Provider Enumeration Date	:	08/23/2018
Last Update Date	:	03/04/2020

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