Provider Demographics
NPI:1063417061
Name:GANIK, RON (DDS)
Entity type:Individual
Prefix:DR
First Name:RON
Middle Name:
Last Name:GANIK
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 1:30 E 40TH ST
Mailing Address - Street 2:SUITE 506
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1201
Mailing Address - Country:US
Mailing Address - Phone:212-685-8200
Mailing Address - Fax:212-685-8207
Practice Address - Street 1:30 EAST 40TH STREET
Practice Address - Street 2:RM 506
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1216
Practice Address - Country:US
Practice Address - Phone:212-685-8200
Practice Address - Fax:212-685-8207
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0372541223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics