Provider Demographics
NPI:1669798708
Name:GHASSAN ARO DDS PROFFESSIONAL DENTAL CORP
Entity type:Organization
Organization Name:GHASSAN ARO DDS PROFFESSIONAL DENTAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST /PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GHASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-541-4290
Mailing Address - Street 1:1100 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2914
Mailing Address - Country:US
Mailing Address - Phone:805-541-4290
Mailing Address - Fax:805-541-4295
Practice Address - Street 1:1100 GROVE ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2914
Practice Address - Country:US
Practice Address - Phone:805-541-4290
Practice Address - Fax:805-541-4295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA490541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty