Provider Demographics
NPI:1659383206
Name:GHAZAL, CAROLYN G (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:G
Last Name:GHAZAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10797 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3858
Mailing Address - Country:US
Mailing Address - Phone:909-581-0888
Mailing Address - Fax:909-581-1977
Practice Address - Street 1:2860 MICHELLE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-1009
Practice Address - Country:US
Practice Address - Phone:714-508-3600
Practice Address - Fax:714-368-2092
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA386821223G0001X
NV49871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice