Provider Demographics
NPI:1194860643
Name:ATALLA, GHASSAN S (DDS)
Entity Type:Individual
Prefix:
First Name:GHASSAN
Middle Name:S
Last Name:ATALLA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WEST BROADWAY
Mailing Address - Street 2:WEST BROADWAY DENTAL
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07505
Mailing Address - Country:US
Mailing Address - Phone:973-684-3803
Mailing Address - Fax:973-742-8223
Practice Address - Street 1:1 WEST BROADWAY
Practice Address - Street 2:WEST BROADWAY DENTAL
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505
Practice Address - Country:US
Practice Address - Phone:973-684-3803
Practice Address - Fax:973-742-8223
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1021978001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics