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General NPI Number Information
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NPI Number | 1407066517
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Entity Type | Organization
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Legal Business Name | NEXT GENERATION DENTAL GROUP
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 05/08/2017
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Provider Practice Location Address
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Address Line | 180 W END AVE SUITE 1F
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City | NEW YORK
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State | NY
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Zip | 10023-4902
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Country | US
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Telephone | 212-799-5310
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Fax |
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Provider Business Mailing Address
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Address Line | 180 W END AVE SUITE 1F
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City | NEW YORK
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State | NY
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Zip | 10023-4902
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Country | US
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Telephone | 212-799-5310
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. BENJAMIN P GANJIAN
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Credential | DDS
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Telephone | 212-799-5310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 055832
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 053917
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 054071
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 051965
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 050559
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License Number State | NY
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