Provider Demographics
NPI:1205529815
Name:AL HALAK, MOHAMAD GHAITH (DDS)
Entity type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:GHAITH
Last Name:AL HALAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 BROWNSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2560
Mailing Address - Country:US
Mailing Address - Phone:304-282-2825
Mailing Address - Fax:
Practice Address - Street 1:1554 MILEGROUND RD STE A
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3749
Practice Address - Country:US
Practice Address - Phone:304-282-2825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV46221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice