Provider Demographics
NPI:1649489451
Name:GHARIBEH, MARCELLE R (DDS)
Entity type:Individual
Prefix:
First Name:MARCELLE
Middle Name:R
Last Name:GHARIBEH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 E 92ND ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-4502
Mailing Address - Country:US
Mailing Address - Phone:773-978-1231
Mailing Address - Fax:
Practice Address - Street 1:3009 E 92ND ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-4502
Practice Address - Country:US
Practice Address - Phone:773-978-1231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190271131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice