Provider Demographics
NPI:1750476107
Name:GHIAI, SYAMAK (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:SYAMAK
Middle Name:
Last Name:GHIAI
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2189 CLEVELAND ST STE 252
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3243
Mailing Address - Country:US
Mailing Address - Phone:813-767-0489
Mailing Address - Fax:813-991-4817
Practice Address - Street 1:2194 DREW ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3214
Practice Address - Country:US
Practice Address - Phone:813-991-1088
Practice Address - Fax:813-991-4817
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN123181223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics