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	5645	NC

General Provider Information

NPI Number	:	1437283330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD VANGURP DDS PLLC

Provider Business Mailing Address
First Line	:	337 KINDLING WOOD LN
Second Line	:
City	:	MARVIN
State	:	NC
Zip	:	28173-6802
Country	:	US
Telephone Number	:	704-843-2272
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	04/19/2017

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