Provider Demographics
NPI:1285896159
Name:PYG DENTAL MANAGEMENT
Entity type:Organization
Organization Name:PYG DENTAL MANAGEMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:GANGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-581-9228
Mailing Address - Street 1:1600 N STATE ROAD 7 STE 400
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-5853
Mailing Address - Country:US
Mailing Address - Phone:954-581-9228
Mailing Address - Fax:
Practice Address - Street 1:1600 N STATE ROAD 7 STE 400
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-5853
Practice Address - Country:US
Practice Address - Phone:954-581-9228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15530261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075433100Medicaid
FL070691400Medicaid