Syamack Ganjavian, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

G10001184 Issued in DE

Practice address

129 S West St
Wilmington, DE 19801-5014

Phone

(302) 230-0000

Fax

(302) 295-3607

NPI assigned

Nov 21, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in DE

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Crescent Dental, LLC

  • Dentist
  • Wilmington, DE
  • NPI 1851569719
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460851200000",
    "number": "1487729786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 S WEST ST",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198015014",
            "telephone_number": "302-230-0000",
            "fax_number": "302-295-3607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 S WEST ST",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198015014",
            "telephone_number": "302-230-0000",
            "fax_number": "302-295-3607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANJAVIAN",
        "first_name": "SYAMACK",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-21",
        "last_updated": "2016-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "DE",
            "license": "G10001184",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "13505",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS036982",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000033854",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cheryl K Gamble, CRNA
• Simran Gandhi, DO
• Deepa Ganesan, MSN
• Deborah Louise Gangemi, P.T.
• Thomas Joseph Gangemi, P.T.
• Jamie Ganley, CRNP
• Annette Suzanne Gannon
• Anthony W Gannon, M.D.
• Sharon M Gannon, RPH
• Amber Marie Garbe, CNM

• General Practice Dentistry in Wilmington, DE
• Providers in Wilmington, DE by specialty
• General Practice Dentistry in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.