Provider Demographics
NPI:1437283330
Name:VANGURP, RICHARD (DDS PLLC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:VANGURP
Suffix:
Gender:M
Credentials:DDS PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 KINDLING WOOD LN
Mailing Address - Street 2:
Mailing Address - City:MARVIN
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6802
Mailing Address - Country:US
Mailing Address - Phone:704-843-2272
Mailing Address - Fax:
Practice Address - Street 1:3111 SPRINGBANK LN STE F
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3373
Practice Address - Country:US
Practice Address - Phone:704-542-2884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC56451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice