1285262667 NPI number — GANGLANI DMD PLLC

Table of content: OUSMANE VAZOUMANA DOSSO PHARMD (NPI 1356187595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285262667 NPI number — GANGLANI DMD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GANGLANI DMD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285262667
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1110 CHURCHILL COMMONS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28211-1396
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-410-0044
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6611 OLD MONROE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIAN TRAIL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28079-5352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-218-2132
Provider Business Practice Location Address Fax Number:
888-977-1574
Provider Enumeration Date:
03/31/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VELAZQUE
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
704-516-0275

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)