Provider Demographics
NPI:1730276619
Name:GANES, ERIC M (DDS)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:M
Last Name:GANES
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:BOX 638
Mailing Address - Street 2:
Mailing Address - City:KENMARE
Mailing Address - State:ND
Mailing Address - Zip Code:58746-0638
Mailing Address - Country:US
Mailing Address - Phone:701-385-4041
Mailing Address - Fax:701-385-4986
Practice Address - Street 1:318 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:KENMARE
Practice Address - State:ND
Practice Address - Zip Code:58746-0638
Practice Address - Country:US
Practice Address - Phone:701-385-4041
Practice Address - Fax:701-385-4986
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1792122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND41118Medicaid