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General NPI Number Information
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NPI Number | 1598055527
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Entity Type | Organization
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Legal Business Name | GANJI DENTAL CORPORATION
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Dates
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Enumeration Date | 04/11/2011
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Last Update Date | 08/24/2012
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Provider Practice Location Address
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Address Line | 1005 E WASHINGTON BLVD STE B
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City | LOS ANGELES
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State | CA
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Zip | 90021-3020
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Country | US
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Telephone | 213-765-0004
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Fax |
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Provider Business Mailing Address
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Address Line | 1005 E WASHINGTON BLVD STE B
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City | LOS ANGELES
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State | CA
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Zip | 90021-3020
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Country | US
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Telephone | 213-765-0004
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Fax | 213-765-4949
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Authorized Official
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Title or Position | PART OWNER
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Name | DAVID GANJI
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Credential | DMD
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Telephone | 213-765-0004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 58353
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 58334
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License Number State | CA
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