Provider Demographics
NPI:1134515653
Name:ROSHEN G GANESH DDS, PDD, INC
Entity Type:Organization
Organization Name:ROSHEN G GANESH DDS, PDD, INC
Other - Org Name:SANTA MONICA ESTHETIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GANESH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-458-4000
Mailing Address - Street 1:1418 7TH ST
Mailing Address - Street 2:#101
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2694
Mailing Address - Country:US
Mailing Address - Phone:310-458-4000
Mailing Address - Fax:310-458-4003
Practice Address - Street 1:1418 7TH ST
Practice Address - Street 2:#101
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2694
Practice Address - Country:US
Practice Address - Phone:310-458-4000
Practice Address - Fax:310-458-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA497521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty