Provider Demographics
NPI:1588634216
Name:GANESHKUMAR, NADARAJAH (DMD)
Entity Type:Individual
Prefix:
First Name:NADARAJAH
Middle Name:
Last Name:GANESHKUMAR
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 1:10 WALTERS WAY
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-4590
Mailing Address - Country:US
Mailing Address - Phone:781-296-0503
Mailing Address - Fax:
Practice Address - Street 1:750 CENTRAL AVE STE K
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3434
Practice Address - Country:US
Practice Address - Phone:781-296-0503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH034111223P0221X
DEG3-00004591223P0221X
DEG5-00013061223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1588634216Medicaid
NH30306568Medicaid