Ganglani Wake Forest PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

GANGLANI WAKE FOREST PLLC

Practice address

1704 S Main St # 110
Wake Forest, NC 27587-7323

Phone

(919) 556-6200

NPI assigned

Jul 3, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Chad Hendricks

Title

Credentialing

Phone

(612) 859-0444

Specialties & licenses 1

Addresses

Other names 1

• Supremia Dentistry Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1719964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719964800000",
    "number": "1255177705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1704 S MAIN ST # 110",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275877323",
            "telephone_number": "919-556-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1704 S MAIN ST # 110",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275877323",
            "telephone_number": "919-556-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GANGLANI WAKE FOREST PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-03",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A",
        "authorized_official_last_name": "HENDRICKS",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "612-859-0444"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Supremia Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gahc3 Wake Forest NC TRS Sub, LLC
• Edward Michael Galiczynski Jr., DO
• Sheila Marie Gallagher-Whitlock, PT
• Katherine Elizabeth Gambino, PA-C
• Meghan Lucy Clair Gamelin, M.D.
• Cameron Yessenia Garcia
• Austin John Gardner, PT, DPT
• Robert W Gardner, M.D.
• Valarie Tucker Gardner, MSW, LCSW
• Gastroenterology & Hepatology Consultants, PA

• General Practice Dentistry in Wake Forest, NC
• Providers in Wake Forest, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.