Provider Demographics
NPI:1457732513
Name:GHIBU, ANA (DMD)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:GHIBU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 STATE RD
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-6265
Mailing Address - Country:US
Mailing Address - Phone:440-992-3146
Mailing Address - Fax:440-998-6932
Practice Address - Street 1:8162 E SANTA ANA CANYON RD STE 104
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-1154
Practice Address - Country:US
Practice Address - Phone:714-202-0765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0245211223G0001X
CA1036071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice