MEDICARE: JOANA GUTIERREZ GANESHAPPA DDS

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	122300000X	Dentist	21268	TX

General Provider Information

NPI Number	:	1871553610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANA GUTIERREZ GANESHAPPA DDS

Provider Business Mailing Address
First Line	:	10 WESTERLEIGH
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-1799
Country	:	US
Telephone Number	:	210-381-1730
Fax Number	:

Provider Business Practice Location Address
First Line	:	4455 HARRY WURZBACH RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-2402
Country	:	US
Telephone Number	:	210-822-4664
Fax Number	:	210-822-4878

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	07/08/2007

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