Provider Demographics
NPI:1093150542
Name:GANESAN, LAKSHMI (DDS)
Entity Type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:
Last Name:GANESAN
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 1:111 W MAIN ST
Mailing Address - Street 2:2B
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1910
Mailing Address - Country:US
Mailing Address - Phone:510-364-7716
Mailing Address - Fax:
Practice Address - Street 1:415 LANSING ST
Practice Address - Street 2:OH 101
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2855
Practice Address - Country:US
Practice Address - Phone:317-274-8822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011434A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist