Provider Demographics
NPI:1639129836
Name:GANGJI, RIYAZ K (DDS)
Entity Type:Individual
Prefix:DR
First Name:RIYAZ
Middle Name:K
Last Name:GANGJI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-5075
Mailing Address - Country:US
Mailing Address - Phone:610-861-0190
Mailing Address - Fax:610-861-3771
Practice Address - Street 1:2431 EASTON AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-5075
Practice Address - Country:US
Practice Address - Phone:610-861-0190
Practice Address - Fax:610-861-3771
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028456L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice