Provider Demographics
NPI:1356420186
Name:PANGILINAN, PETER JAMES (DDS)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:JAMES
Last Name:PANGILINAN
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 1:9615 KINCEY AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-9140
Mailing Address - Country:US
Mailing Address - Phone:704-659-6765
Mailing Address - Fax:304-624-0977
Practice Address - Street 1:9615 KINCEY AVE STE 110
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-9140
Practice Address - Country:US
Practice Address - Phone:704-659-6765
Practice Address - Fax:704-659-3351
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC105131223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001750853OtherUNITED CONCORDIA
001750853OtherBCBS
WV3810000420Medicaid
001750853OtherUNITED CONCORDIA
WVV03731Medicare UPIN
V03731Medicare UPIN
WV3810000420Medicaid
WV4151281Medicare PIN