Provider Demographics
NPI:1023881026
Name:GHAZALI DENTAL PLLC
Entity type:Organization
Organization Name:GHAZALI DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAMZAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ALGHAZALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-754-9261
Mailing Address - Street 1:8711 DIGGES RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4403
Mailing Address - Country:US
Mailing Address - Phone:703-368-9777
Mailing Address - Fax:
Practice Address - Street 1:8711 DIGGES RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4403
Practice Address - Country:US
Practice Address - Phone:703-368-9777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty