Provider Demographics
NPI:1750498507
Name:GHORAB, JUMANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUMANA
Middle Name:
Last Name:GHORAB
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 1:2550 E GUADALUPE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-5114
Mailing Address - Country:US
Mailing Address - Phone:480-545-0724
Mailing Address - Fax:480-545-0743
Practice Address - Street 1:2550 E GUADALUPE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5114
Practice Address - Country:US
Practice Address - Phone:480-545-0724
Practice Address - Fax:480-545-0743
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ53011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice