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General NPI Number Information
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NPI Number | 1265509921
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Entity Type | Individual
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Provider Name | STEVEN ISAAC GANZBERG DMD
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Gender | Male
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 05/17/2013
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Provider Practice Location Address
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Address Line | 10833 LECONTE AVE 53-039 CHS
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City | LOS ANGELES
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State | CA
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Zip | 90095-1668
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Country | US
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Telephone | 310-825-9300
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Fax | 877-352-0109
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Provider Business Mailing Address
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Address Line | 10833 LECONTE AVE 53-039 CHS
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City | LOS ANGELES
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State | CA
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Zip | 90095-1668
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Country | US
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Telephone | 310-825-9300
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Fax | 877-352-0109
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 60746
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License Number State | CA
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