Provider Demographics
NPI:1437531795
Name:GANESAN, SUKIRTH MURTHY (BDS)
Entity Type:Individual
Prefix:
First Name:SUKIRTH
Middle Name:MURTHY
Last Name:GANESAN
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:SUKIRTHMURTHY
Other - Middle Name:
Other - Last Name:GANESAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:322 DENTAL SCIENCE BLDG S
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1001
Mailing Address - Country:US
Mailing Address - Phone:319-335-7440
Mailing Address - Fax:319-335-7451
Practice Address - Street 1:801 NEWTON RD
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242
Practice Address - Country:US
Practice Address - Phone:319-319-3357
Practice Address - Fax:319-335-7239
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRES.35411223P0300X
IA401891223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics