Provider Demographics
NPI:1730269804
Name:GANGEL, LARRY JOSEPH (DDS)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:JOSEPH
Last Name:GANGEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 CLAIRBORNE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062
Mailing Address - Country:US
Mailing Address - Phone:913-782-3382
Mailing Address - Fax:913-782-2978
Practice Address - Street 1:405 CLAIRBORNE
Practice Address - Street 2:SUITE 3
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062
Practice Address - Country:US
Practice Address - Phone:913-782-3382
Practice Address - Fax:913-782-2978
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4468122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist