MEDICARE: KETAN G GINOYA DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	16179	MD
2	1223G0001X	General Practice Dentistry	DN014859	GA
3	1223G0001X	General Practice Dentistry	DN1855814	MA

General Provider Information

NPI Number	:	1033497409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KETAN G GINOYA DMD

Provider Business Mailing Address
First Line	:	4511 CHAMBLEE DUNWOODY RD STE A2
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30338-6243
Country	:	US
Telephone Number	:	404-806-9799
Fax Number	:

Provider Business Practice Location Address
First Line	:	4511 CHAMBLEE DUNWOODY RD STE A2
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30338-6243
Country	:	US
Telephone Number	:	404-806-9799
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2011
Last Update Date	:	09/19/2024

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