Provider Demographics
NPI:1689900045
Name:GANEM, IVONNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:IVONNE
Middle Name:
Last Name:GANEM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3904
Mailing Address - Country:US
Mailing Address - Phone:215-923-2233
Mailing Address - Fax:888-608-7353
Practice Address - Street 1:200 WALNUT ST.
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3904
Practice Address - Country:US
Practice Address - Phone:215-923-2233
Practice Address - Fax:888-608-7353
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0377031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice