Provider Demographics
NPI:1851518799
Name:DAVID G. NANGLE
Entity Type:Organization
Organization Name:DAVID G. NANGLE
Other - Org Name:BEAUTIFUL SMILES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:NANGLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-253-4902
Mailing Address - Street 1:3853 MANDY RUE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-9495
Mailing Address - Country:US
Mailing Address - Phone:315-685-1914
Mailing Address - Fax:
Practice Address - Street 1:213 NORTH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1246
Practice Address - Country:US
Practice Address - Phone:315-253-4902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0385411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00842439Medicaid