Provider Demographics
NPI:1558572644
Name:GANGOY, MARY ANGELIC (DMD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANGELIC
Last Name:GANGOY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W WATER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-2907
Mailing Address - Country:US
Mailing Address - Phone:781-245-1113
Mailing Address - Fax:781-246-8441
Practice Address - Street 1:1 W WATER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-2907
Practice Address - Country:US
Practice Address - Phone:781-245-1113
Practice Address - Fax:781-246-8441
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN193421223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics