Provider Demographics
NPI:1518327634
Name:DRS. GANGLANI, JOHAL, DUNNING & ASSOCIATES PLLC, II
Entity Type:Organization
Organization Name:DRS. GANGLANI, JOHAL, DUNNING & ASSOCIATES PLLC, II
Other - Org Name:FRESH DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAXER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-549-9922
Mailing Address - Street 1:331 INDIAN TRAIL RD N
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-7624
Mailing Address - Country:US
Mailing Address - Phone:704-684-0195
Mailing Address - Fax:
Practice Address - Street 1:331 INDIAN TRAIL RD N
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-7624
Practice Address - Country:US
Practice Address - Phone:704-684-0195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty