Provider Demographics
NPI:1174191563
Name:GANGLANI DMD PLLC
Entity Type:Organization
Organization Name:GANGLANI DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF IMPLEMENTATION
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:VELAZQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-218-2132
Mailing Address - Street 1:2935 PROVIDENCE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2762
Mailing Address - Country:US
Mailing Address - Phone:704-516-0275
Mailing Address - Fax:866-594-2098
Practice Address - Street 1:2935 PROVIDENCE RD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2762
Practice Address - Country:US
Practice Address - Phone:704-516-0275
Practice Address - Fax:866-594-2098
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GANGLANI DMD PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty