Provider Demographics
NPI:1023166543
Name:GANZ, SCOTT DAVIE (DMD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DAVIE
Last Name:GANZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 LINWOOD PLZ
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-3761
Mailing Address - Country:US
Mailing Address - Phone:201-592-8888
Mailing Address - Fax:201-592-8821
Practice Address - Street 1:158 LINWOOD PLZ
Practice Address - Street 2:SUITE 204
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-3761
Practice Address - Country:US
Practice Address - Phone:201-592-8888
Practice Address - Fax:201-592-8821
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ138701223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics