Provider Demographics
NPI:1376954578
Name:GANZ, ABRAHAM J (DMD)
Entity Type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:J
Last Name:GANZ
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 1:1326 OCEAN AVE APT 8N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-3273
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1701 SUNRISE HWY SPC NOC7
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6091
Practice Address - Country:US
Practice Address - Phone:631-666-1440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-11
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI024889001223X0400X
NY057226-11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty