MEDICARE: DR. GERALD W GANZ DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	28153	CA

General Provider Information

NPI Number	:	1174665459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALD W GANZ DDS

Provider Business Mailing Address
First Line	:	2618 LOS COYOTES DIAGONAL
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815
Country	:	US
Telephone Number	:	562-425-1196
Fax Number	:	562-497-2551

Provider Business Practice Location Address
First Line	:	2618 LOS COYOTES DIAGONAL
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815
Country	:	US
Telephone Number	:	562-425-1196
Fax Number	:	562-497-2551

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/08/2007

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