MEDICARE: KELLY GANZEN

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	1922679943	UT
2	122300000X	Dentist	12324093-9922	UT

General Provider Information

NPI Number	:	1922679943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY GANZEN

Provider Business Mailing Address
First Line	:	1501 ISLAND AVE APT 415
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-8012
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	UNIT 100111 BOX 1
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96629-1100
Country	:	US
Telephone Number	:	619-545-1148
Fax Number	:

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

Provider Enumeration Date	:	07/09/2021
Last Update Date	:	07/06/2022

Similar Medicare Providers

1376831560 — DR. CHRISTOPHER M ROCK D.O.
Practice Location Address:

UNIT 100111 BOX 1
FPO, AP
96629-1100

Practice Phone: 619-545-3616
Practice Fax:

1780207787 — DR. JOSHUA CHO DMD
Practice Location Address:

UNIT 100111 BOX 1
FPO, AP
96629-1100

Practice Phone: 619-545-5802
Practice Fax:

1457636888 — MR. JAMES DARRELL ABBOTT ARNP
Practice Location Address:

PSC 557 BOX 1151
FPO, AP
96379-1100

Practice Phone: 08064954367
Practice Fax:

1114229317 — DR. BRIAN DAVID EVANS DMD
Practice Location Address:

USS CARL VINSON CVN70 , UNIT 1000111 BOX 1770
FPO, AP
96629

Practice Phone: 619-545-4814
Practice Fax:

1679844229 — MR. NATHAN WILLIAM BURGER IDC
Practice Location Address:

USS CARL VINSON , CVN 70
FPO, AP
96629-2840

Practice Phone: 619-545-7882
Practice Fax:

1326397597 — MR. RICARDO VANN JR. IDC
Practice Location Address:

HM2 VANN, RICARDO , MED
FPO, AP
96629

Practice Phone: 619-545-3616
Practice Fax:

Directions to “ KELLY GANZEN ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.