Provider Demographics
NPI:1053551317
Name:CAROLYN GHAZAL, D.D.S., INC
Entity type:Organization
Organization Name:CAROLYN GHAZAL, D.D.S., INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:G
Authorized Official - Last Name:GHAZAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-679-1667
Mailing Address - Street 1:2860 MICHELLE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1009
Mailing Address - Country:US
Mailing Address - Phone:714-368-2077
Mailing Address - Fax:714-368-2092
Practice Address - Street 1:29950 HAUN RD
Practice Address - Street 2:STE 302
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586-6526
Practice Address - Country:US
Practice Address - Phone:951-679-1667
Practice Address - Fax:951-679-8664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty