Provider Demographics
NPI:1649324112
Name:GHAZAL, ALEXANDRE (DMD)
Entity type:Individual
Prefix:
First Name:ALEXANDRE
Middle Name:
Last Name:GHAZAL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:GHAZAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:1950 LAUREL MANOR DR
Mailing Address - Street 2:BLDG#184
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-5603
Mailing Address - Country:US
Mailing Address - Phone:352-753-0150
Mailing Address - Fax:352-750-8072
Practice Address - Street 1:1950 LAUREL MANOR DR
Practice Address - Street 2:BLDG#184
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5603
Practice Address - Country:US
Practice Address - Phone:352-753-0150
Practice Address - Fax:352-750-8072
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15659122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist