Provider Demographics
NPI:1609082833
Name:GANGA, MYSORE SANATHKUMAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:MYSORE
Middle Name:SANATHKUMAR
Last Name:GANGA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 IRENE LN S
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1916
Mailing Address - Country:US
Mailing Address - Phone:516-470-0852
Mailing Address - Fax:
Practice Address - Street 1:7517 41ST AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1004
Practice Address - Country:US
Practice Address - Phone:718-803-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0510641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02489976Medicaid