Provider Demographics
NPI:1093012056
Name:CHERIAN & GANTA DENTAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CHERIAN & GANTA DENTAL ASSOCIATES, LLC
Other - Org Name:DELMARVA CENTER FOR DENTAL EXCELLENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:DI ANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-242-7472
Mailing Address - Street 1:230 S BRIDGE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5915
Mailing Address - Country:US
Mailing Address - Phone:302-565-7539
Mailing Address - Fax:
Practice Address - Street 1:230 S BRIDGE ST
Practice Address - Street 2:SUITE A
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5915
Practice Address - Country:US
Practice Address - Phone:302-565-7539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-26
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD147081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty