1982623617 NPI number — NEIL IRA GANZ DDS

Table of content: NEIL IRA GANZ DDS (NPI 1982623617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982623617 NPI number — NEIL IRA GANZ DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GANZ
Provider First Name:
NEIL
Provider Middle Name:
IRA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982623617
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
440 S LINCOLN AVE
Provider Second Line Business Mailing Address:
SUITE B10
Provider Business Mailing Address City Name:
STEAMBOAT SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80487-8916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-879-5630
Provider Business Mailing Address Fax Number:
970-879-0703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
440 S LINCOLN AVE
Provider Second Line Business Practice Location Address:
SUITE B10
Provider Business Practice Location Address City Name:
STEAMBOAT SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80487-8916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-879-5630
Provider Business Practice Location Address Fax Number:
970-879-0703
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  6852 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 65635701 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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