Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 13870 | NJ |
NPI | 1023166543 |
---|---|
Provider Name | Dr. Scott Davie Ganz |
First Address | Fort Lee, NJ 07024-3761 |
Second Address | Fort Lee, NJ 07024-3761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 08/07/2007 |