Provider Demographics
NPI:1861539934
Name:GANELES, JEFFREY (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:GANELES
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 1:3020 N MILITARY TRL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-1814
Mailing Address - Country:US
Mailing Address - Phone:561-912-9993
Mailing Address - Fax:561-912-9883
Practice Address - Street 1:3020 N MILITARY TRL
Practice Address - Street 2:SUITE 200
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-1814
Practice Address - Country:US
Practice Address - Phone:561-912-9993
Practice Address - Fax:561-912-9883
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00119791223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics