Healthcare Provider Details

I. General information

NPI: 1407066517
Provider Name (Legal Business Name): NEXT GENERATION DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 05/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 W END AVE SUITE 1F
NEW YORK NY
10023-4902
US

IV. Provider business mailing address

180 W END AVE SUITE 1F
NEW YORK NY
10023-4902
US

V. Phone/Fax

Practice location:
  • Phone: 212-799-5310
  • Fax:
Mailing address:
  • Phone: 212-799-5310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number050559
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number055832
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number053917
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number054071
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number051965
License Number StateNY

VIII. Authorized Official

Name: DR. BENJAMIN P GANJIAN
Title or Position: CEO
Credential: DDS
Phone: 212-799-5310