Provider Demographics
NPI:1336382779
Name:GANESH, RAVI CHAND II (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAVI
Middle Name:CHAND
Last Name:GANESH
Suffix:II
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 1:5403 QUEENS CHAPEL RD
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:301-927-0494
Practice Address - Street 1:5403 QUEENS CHAPEL RD
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:301-927-0494
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14186122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist