Provider Demographics
NPI:1043568751
Name:MAHJOUBI, GHAZAL (DMD)
Entity Type:Individual
Prefix:DR
First Name:GHAZAL
Middle Name:
Last Name:MAHJOUBI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 EAST 6TH STREET APT 3R
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009
Mailing Address - Country:US
Mailing Address - Phone:617-875-5677
Mailing Address - Fax:
Practice Address - Street 1:120 NASSAU AVE BROOKLYN NY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222
Practice Address - Country:US
Practice Address - Phone:718-389-8889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0561471223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery