Provider Demographics
NPI:1417364605
Name:JOSE CANGAS DDS PLLC
Entity type:Organization
Organization Name:JOSE CANGAS DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:CANGAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-830-9332
Mailing Address - Street 1:10564 S US HIGHWAY 15 501 STE E
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-5166
Mailing Address - Country:US
Mailing Address - Phone:214-830-9332
Mailing Address - Fax:
Practice Address - Street 1:10564 S US HIGHWAY 15 501 STE E
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-5166
Practice Address - Country:US
Practice Address - Phone:214-830-9332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-19
Last Update Date:2014-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC93741223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty