Richard Peter Gangwisch, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN008859 Issued in GA

Practice address

912 Killian Hill Rd SW
Suite 100
Lilburn, GA 30047-3138

Phone

(770) 923-3966

Fax

(770) 564-8617

NPI assigned

Jul 26, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gangwisch Dental Group, L.L.C.

  • Dentist
  • Lilburn, GA
  • NPI 1588849186
  NPD (past) Authorized official
• Lilburn Dental Group, L.L.C.

  • General Practice Dentistry
  • Lilburn, GA
  • NPI 1346322989
  NPD (past) Authorized official

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1255355145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "912 KILLIAN HILL RD SW",
            "address_2": "SUITE 100",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300473138",
            "telephone_number": "770-923-3966",
            "fax_number": "770-564-8617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "912 KILLIAN HILL RD SW",
            "address_2": "SUITE 100",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300473138",
            "telephone_number": "770-923-3966",
            "fax_number": "770-564-8617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANGWISCH",
        "first_name": "RICHARD",
        "middle_name": "PETER",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN008859",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30-015431",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• G Craig Heigerick DO PC
• Ga Urgent Care Holdings
• Daniel Gam, DPT
• Gamedical Associates,Inc
• Gangwisch Dental Group, L.L.C.
• Rita Garcia Cabrera, M.S., BCBA
• Randolph Paul Gardner, DMD
• Garhado Enter Prises LLC
• Sherocko Rieshell Gatling-James, FNP
• Andrea Roche Gayden, ANP-BC

• General Practice Dentistry in Lilburn, GA
• Providers in Lilburn, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.