Provider Demographics
NPI:1982623617
Name:GANZ, NEIL IRA (DDS)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:IRA
Last Name:GANZ
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 1:440 S LINCOLN AVE
Mailing Address - Street 2:SUITE B10
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-8916
Mailing Address - Country:US
Mailing Address - Phone:970-879-5630
Mailing Address - Fax:970-879-0703
Practice Address - Street 1:440 S LINCOLN AVE
Practice Address - Street 2:SUITE B10
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-8916
Practice Address - Country:US
Practice Address - Phone:970-879-5630
Practice Address - Fax:970-879-0703
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO68521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO65635701Medicaid