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General NPI Number Information
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NPI Number | 1720197429
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Entity Type | Individual
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Provider Name | FREDERICK J GANJI DDS
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Gender | Male
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 04/06/2009
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Provider Practice Location Address
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Address Line | 16755 SW BASELINE RD SUITE 106
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City | BEAVERTON
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State | OR
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Zip | 97006-4241
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Country | US
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Telephone | 503-533-4001
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Fax | 503-533-4116
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Provider Business Mailing Address
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Address Line | 16755 SW BASELINE RD SUITE 106
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City | BEAVERTON
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State | OR
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Zip | 97006-4241
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Country | US
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Telephone | 503-533-4001
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Fax | 503-533-4116
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE00010130
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License Number State | WA
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