Provider Demographics
NPI:1467545657
Name:CAROLYN G. GHAZAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:CAROLYN G. GHAZAL DENTAL CORPORATION
Other - Org Name:DESERT CROSSING DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:PARISH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-674-9666
Mailing Address - Street 1:2860 MICHELLE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1009
Mailing Address - Country:US
Mailing Address - Phone:714-508-3600
Mailing Address - Fax:714-368-2092
Practice Address - Street 1:72333 HIGHWAY 111
Practice Address - Street 2:STE. B
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-2790
Practice Address - Country:US
Practice Address - Phone:760-674-9666
Practice Address - Fax:760-674-8876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA323771223G0001X
CA377721223P0300X
CA500801223S0112X
CA426991223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty