Provider Demographics
NPI:1265509921
Name:GANZBERG, STEVEN ISAAC (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ISAAC
Last Name:GANZBERG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10833 LECONTE AVE
Mailing Address - Street 2:53-039 CHS
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1668
Mailing Address - Country:US
Mailing Address - Phone:310-825-9300
Mailing Address - Fax:877-352-0109
Practice Address - Street 1:10833 LECONTE AVE
Practice Address - Street 2:53-039 CHS
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1668
Practice Address - Country:US
Practice Address - Phone:310-825-9300
Practice Address - Fax:877-352-0109
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA607461223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T22004Medicare UPIN