Provider Demographics
NPI:1194998799
Name:P.M.GANGI D.M.D.,INC.
Entity type:Organization
Organization Name:P.M.GANGI D.M.D.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:GANGI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-683-4114
Mailing Address - Street 1:13 BRANCH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-1963
Mailing Address - Country:US
Mailing Address - Phone:978-683-4114
Mailing Address - Fax:978-687-4491
Practice Address - Street 1:13 BRANCH ST
Practice Address - Street 2:STE 2
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-1975
Practice Address - Country:US
Practice Address - Phone:978-683-4114
Practice Address - Fax:978-687-4491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty