Provider Demographics
NPI:1083753305
Name:GEORGE G. GHOSN D.D.S.,P.S.
Entity Type:Organization
Organization Name:GEORGE G. GHOSN D.D.S.,P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:GHOSN
Authorized Official - Last Name:GHOSN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-845-7911
Mailing Address - Street 1:604 S MERIDIAN
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-5998
Mailing Address - Country:US
Mailing Address - Phone:253-845-7911
Mailing Address - Fax:253-845-1475
Practice Address - Street 1:604 S MERIDIAN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-5998
Practice Address - Country:US
Practice Address - Phone:253-845-7911
Practice Address - Fax:253-845-1475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0033711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty