Provider Demographics
NPI:1558006049
Name:ABU GHOSH, MAIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAIS
Middle Name:
Last Name:ABU GHOSH
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 1:334 N WILLES DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-5485
Mailing Address - Country:US
Mailing Address - Phone:904-868-3249
Mailing Address - Fax:
Practice Address - Street 1:334 N WILLES DR
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-5485
Practice Address - Country:US
Practice Address - Phone:904-868-3249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12168185-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice