Provider Demographics
NPI:1497924146
Name:GHORAB, DANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:
Last Name:GHORAB
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 AVENIDA TALEGA
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6532
Mailing Address - Country:US
Mailing Address - Phone:949-218-1404
Mailing Address - Fax:
Practice Address - Street 1:801 AVENIDA TALEGA
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6532
Practice Address - Country:US
Practice Address - Phone:949-218-1404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54959122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist