Active NPI
Peter James Pangilinan, DDS
- Oral and Maxillofacial Surgery (Dentist)
- Huntersville, NC
National Provider Identifier
1356420186
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 10513
- Practice address
- 9615 Kincey Ave Ste 110
Huntersville, NC 28078-9140 - Phone
- (704) 659-6765
- Fax
- (704) 659-3351
- NPI assigned
- Nov 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 10513 | NC | Primary |
Addresses
Primary practice location
9615 Kincey Ave Ste 110
Huntersville, NC 28078-9140
Mailing address
9615 Kincey Ave Ste 110
Huntersville, NC 28078-9140
Phone (704) 659-6765
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2022 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10513 | NC | MD | Professional Counselor |
| 3417 | WV | MD | Vascular Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704758400000",
"number": "1356420186",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9615 KINCEY AVE STE 110",
"city": "HUNTERSVILLE",
"state": "NC",
"postal_code": "280789140",
"telephone_number": "704-659-6765",
"fax_number": "304-624-0977"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9615 KINCEY AVE STE 110",
"city": "HUNTERSVILLE",
"state": "NC",
"postal_code": "280789140",
"telephone_number": "704-659-6765",
"fax_number": "704-659-3351"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PANGILINAN",
"first_name": "PETER",
"middle_name": "JAMES",
"name_prefix": "Mr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-03",
"last_updated": "2024-01-09",
"certification_date": "2024-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "NC",
"license": "10513",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Huntersville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.