MEDICARE: DR. SHEELA BANGALORE D.M.D

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	122300000X	Dentist	12355	NC

General Provider Information

NPI Number	:	1609280817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHEELA BANGALORE D.M.D

Provider Business Mailing Address
First Line	:	1524 MONTVALE GRANT WAY
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27519-1017
Country	:	US
Telephone Number	:	949-923-8477
Fax Number	:

Provider Business Practice Location Address
First Line	:	3434 KILDAIRE FARM RD
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27518-2277
Country	:	US
Telephone Number	:	919-629-7516
Fax Number	:

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

Provider Enumeration Date	:	06/16/2014
Last Update Date	:	05/16/2024

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