Provider Demographics
NPI:1225841539
Name:GANJI & GANJI DMD DENTAL CORPORATION
Entity type:Organization
Organization Name:GANJI & GANJI DMD DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GANJI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:818-439-9954
Mailing Address - Street 1:BUSINESS CENTER
Mailing Address - Street 2:500 E CARSON ST SUITE 207
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745
Mailing Address - Country:US
Mailing Address - Phone:818-439-9954
Mailing Address - Fax:
Practice Address - Street 1:13109 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-4416
Practice Address - Country:US
Practice Address - Phone:310-775-2557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty