Provider Demographics
NPI:1790990638
Name:GHAREEB AND GHAREEB, DDS, PC
Entity Type:Organization
Organization Name:GHAREEB AND GHAREEB, DDS, PC
Other - Org Name:GHAREEB DENTAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:AMOS
Authorized Official - Last Name:GHAREEB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-744-3333
Mailing Address - Street 1:1203 JEFFERSON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-9732
Mailing Address - Country:US
Mailing Address - Phone:304-744-3333
Mailing Address - Fax:304-744-8245
Practice Address - Street 1:1203 JEFFERSON RD
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-9732
Practice Address - Country:US
Practice Address - Phone:304-744-3333
Practice Address - Fax:304-744-8245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV381-000-4849Medicaid