Provider Demographics
NPI:1659774123
Name:MORAD, GHINA (DMD)
Entity Type:Individual
Prefix:DR
First Name:GHINA
Middle Name:
Last Name:MORAD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WOODHILL DR
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-1827
Mailing Address - Country:US
Mailing Address - Phone:650-996-4685
Mailing Address - Fax:801-780-9009
Practice Address - Street 1:2920 BROADWAY
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1578
Practice Address - Country:US
Practice Address - Phone:650-592-6396
Practice Address - Fax:650-592-6241
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49149122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist