Provider Demographics
NPI:1437562972
Name:GHATTAS, MARY HANNA (DMD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:HANNA
Last Name:GHATTAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:SAMY
Other - Last Name:HANNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 PRESIDENTS WAY APT 1319
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-4568
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1247 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5273
Practice Address - Country:US
Practice Address - Phone:617-738-0806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18565821223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist