Provider Demographics
NPI:1083927347
Name:DARWISH, GHASSAN MUSTAFA (BDS)
Entity Type:Individual
Prefix:
First Name:GHASSAN
Middle Name:MUSTAFA
Last Name:DARWISH
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BANKS PL
Mailing Address - Street 2:APT #303
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-6145
Mailing Address - Country:US
Mailing Address - Phone:617-416-7097
Mailing Address - Fax:
Practice Address - Street 1:1 KNEELAND ST
Practice Address - Street 2:5TH FLOOR OF TUFTS DENTAL SCHOOL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1527
Practice Address - Country:US
Practice Address - Phone:617-636-6515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL10979282N00000X
MADL11956282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital