Organization
GANGLANI WAKE FOREST PLLC
Active
Other names
Supremia Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD HENDRICKS (CREDENTIALING)
(612) 859-0444
Entity
Organization
Contact information
Practice address
1704 S MAIN ST # 110, WAKE FOREST, NC 27587-7323
(919) 556-6200
Mailing address
1704 S MAIN ST # 110, WAKE FOREST, NC 27587-7323
(919) 556-6200
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
07/03/2024
Last updated
07/03/2024
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