Provider Demographics
NPI:1619379807
Name:DARWISH, GHAITH (DDS)
Entity Type:Individual
Prefix:
First Name:GHAITH
Middle Name:
Last Name:DARWISH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 W BARRY AVE
Mailing Address - Street 2:APT 512
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5545
Mailing Address - Country:US
Mailing Address - Phone:773-354-7597
Mailing Address - Fax:
Practice Address - Street 1:421 W BARRY AVE
Practice Address - Street 2:APT 512
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5545
Practice Address - Country:US
Practice Address - Phone:773-354-7597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019030010122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist