Provider Demographics
NPI:1083776017
Name:HALWANI, GHIATH
Entity Type:Individual
Prefix:
First Name:GHIATH
Middle Name:
Last Name:HALWANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 MOUNDS RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-5713
Mailing Address - Country:US
Mailing Address - Phone:765-642-0400
Mailing Address - Fax:
Practice Address - Street 1:2128 MOUNDS RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-5713
Practice Address - Country:US
Practice Address - Phone:765-642-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120100491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice