Provider Demographics
NPI:1467404715
Name:CANGEMI, CHARLES F (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:F
Last Name:CANGEMI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 BILLINGSLEY RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1066
Mailing Address - Country:US
Mailing Address - Phone:704-347-3900
Mailing Address - Fax:704-347-0133
Practice Address - Street 1:8738 UNIVERSITY CITY BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-3558
Practice Address - Country:US
Practice Address - Phone:704-547-0837
Practice Address - Fax:704-547-1274
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5701122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8991355Medicaid
91355OtherBCBS
2428884Medicare ID - Type UnspecifiedMEDICARE
NC8991355Medicaid