Provider Demographics
NPI:1649268376
Name:GHALY, GEORGE (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:GHALY
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 1:201 BOSTON POST RD W STE 405A
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-4667
Mailing Address - Country:US
Mailing Address - Phone:508-366-1855
Mailing Address - Fax:508-870-0544
Practice Address - Street 1:201 BOSTON POST RD W STE 405
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-4667
Practice Address - Country:US
Practice Address - Phone:508-366-1855
Practice Address - Fax:508-870-0544
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA202151223G0001X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No1223G0001XDental ProvidersDentistGeneral Practice