Provider Demographics
NPI:1306983580
Name:GANGWISCH, ARNOLD C (DMD)
Entity type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:C
Last Name:GANGWISCH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-1736
Mailing Address - Country:US
Mailing Address - Phone:850-271-2341
Mailing Address - Fax:850-271-0679
Practice Address - Street 1:530 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-1736
Practice Address - Country:US
Practice Address - Phone:850-271-2341
Practice Address - Fax:850-271-0679
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN104971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice