Provider Demographics
NPI:1871553610
Name:GANESHAPPA, JOANA GUTIERREZ (DDS)
Entity type:Individual
Prefix:
First Name:JOANA
Middle Name:GUTIERREZ
Last Name:GANESHAPPA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WESTERLEIGH
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-1799
Mailing Address - Country:US
Mailing Address - Phone:210-381-1730
Mailing Address - Fax:
Practice Address - Street 1:4455 HARRY WURZBACH RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2402
Practice Address - Country:US
Practice Address - Phone:210-822-4664
Practice Address - Fax:210-822-4878
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21268122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist