MEDICARE: DR. SYAMACK GANJAVIAN D.D.S.

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	G10001184	DE
2	1223G0001X	General Practice Dentistry	13505	MD
3	1223G0001X	General Practice Dentistry	DS036982	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487729786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SYAMACK GANJAVIAN D.D.S.

Provider Business Mailing Address
First Line	:	129 S WEST ST
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19801-5014
Country	:	US
Telephone Number	:	302-230-0000
Fax Number	:	302-295-3607

Provider Business Practice Location Address
First Line	:	129 S WEST ST
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19801-5014
Country	:	US
Telephone Number	:	302-230-0000
Fax Number	:	302-295-3607

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	04/17/2016

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