Provider Demographics
NPI:1245314822
Name:RAVI GANESH DDS PA
Entity type:Organization
Organization Name:RAVI GANESH DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:CHAND
Authorized Official - Last Name:GANESH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-927-5960
Mailing Address - Street 1:5403 QUEENS CHAPEL ROAD
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3902
Mailing Address - Country:US
Mailing Address - Phone:301-927-5960
Mailing Address - Fax:301-927-8498
Practice Address - Street 1:5403 QUEENS CHAPEL ROAD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-3902
Practice Address - Country:US
Practice Address - Phone:301-927-5960
Practice Address - Fax:301-927-8498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD74241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty