Provider Demographics
NPI:1073245882
Name:GHANTOUS, ZIAD (DMD)
Entity Type:Individual
Prefix:DR
First Name:ZIAD
Middle Name:
Last Name:GHANTOUS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:ZIAD
Other - Middle Name:
Other - Last Name:GHANTOUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:605 W 170TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3201
Mailing Address - Country:US
Mailing Address - Phone:201-755-9858
Mailing Address - Fax:
Practice Address - Street 1:1775 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-8202
Practice Address - Country:US
Practice Address - Phone:718-901-8410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program