Provider Demographics
NPI:1043427016
Name:GANZHA, IRINA V (DDS)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:V
Last Name:GANZHA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 N CAPITOL AVE
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-1016
Mailing Address - Country:US
Mailing Address - Phone:408-719-8600
Mailing Address - Fax:408-719-8609
Practice Address - Street 1:1902 N CAPITOL AVE
Practice Address - Street 2:SUITE # 1
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132-1016
Practice Address - Country:US
Practice Address - Phone:408-719-8600
Practice Address - Fax:408-719-8609
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49523122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist