MEDICARE: DOROTHY LANE DENTAL, GANESH LOGANATHAN, D.D.S., INC.

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	122300000X	Dentist	30019355	OH

General Provider Information

NPI Number	:	1790095271
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOROTHY LANE DENTAL, GANESH LOGANATHAN, D.D.S., INC.

Provider Business Mailing Address
First Line	:	1633 W DOROTHY LN
Second Line	:
City	:	MORAINE
State	:	OH
Zip	:	45439-1836
Country	:	US
Telephone Number	:	937-298-4221
Fax Number	:	937-395-3665

Provider Business Practice Location Address
First Line	:	1633 W DOROTHY LN
Second Line	:
City	:	MORAINE
State	:	OH
Zip	:	45439-1836
Country	:	US
Telephone Number	:	937-298-4221
Fax Number	:	937-395-3665

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GANESH LOGANATHAN
Credential	:	DDS
Telephone Number	:	937-298-4221

Provider Enumeration Date	:	10/18/2010
Last Update Date	:	11/12/2010

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