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General NPI Number Information
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NPI Number | 1851569719
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Entity Type | Organization
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Legal Business Name | CRESCENT DENTAL, LLC
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Dates
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Enumeration Date | 02/13/2008
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 129 S. WEST ST.
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City | WILMINGTON
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State | DE
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Zip | 19801
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Country | US
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Telephone | 302-230-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 120 TALLEYRAND DR
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City | WILMINGTON
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State | DE
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Zip | 19810-3948
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Country | US
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Telephone | 302-230-0000
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SYAMACK GANJAVIAN
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Credential | DDS
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Telephone | 302-230-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | G10001184
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License Number State | DE
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