Provider Demographics
NPI:1538691266
Name:GHOBRIAL, ELARIA IBRAHIM (DDS)
Entity Type:Individual
Prefix:
First Name:ELARIA
Middle Name:IBRAHIM
Last Name:GHOBRIAL
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 1:6114 ROSEDALE DR
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2295
Mailing Address - Country:US
Mailing Address - Phone:817-504-9505
Mailing Address - Fax:
Practice Address - Street 1:5813 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2201
Practice Address - Country:US
Practice Address - Phone:301-853-1567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16376122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist