Provider Demographics
NPI:1285262667
Name:GANGLANI DMD PLLC
Entity type:Organization
Organization Name:GANGLANI DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:VELAZQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-516-0275
Mailing Address - Street 1:1110 CHURCHILL COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1396
Mailing Address - Country:US
Mailing Address - Phone:215-410-0044
Mailing Address - Fax:
Practice Address - Street 1:6611 OLD MONROE RD
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-5352
Practice Address - Country:US
Practice Address - Phone:704-218-2132
Practice Address - Fax:888-977-1574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty