Provider Demographics
NPI:1457976979
Name:GANCZ, ELIEZER (DDS)
Entity type:Individual
Prefix:DR
First Name:ELIEZER
Middle Name:
Last Name:GANCZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ELI
Other - Middle Name:
Other - Last Name:GANCZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2200 KERWIN RD APT 412
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3953
Mailing Address - Country:US
Mailing Address - Phone:216-952-9513
Mailing Address - Fax:
Practice Address - Street 1:4071 LEE RD STE 260
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-2173
Practice Address - Country:US
Practice Address - Phone:216-952-9513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRES.0042561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice