Provider Demographics
NPI:1770965030
Name:GHAZAL, TARIQ (BDS, MS, PHD, DABDPH)
Entity type:Individual
Prefix:DR
First Name:TARIQ
Middle Name:
Last Name:GHAZAL
Suffix:
Gender:M
Credentials:BDS, MS, PHD, DABDPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 SARATOGA BLVD BLDG 1
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3477
Mailing Address - Country:US
Mailing Address - Phone:361-992-9500
Mailing Address - Fax:
Practice Address - Street 1:6200 SARATOGA BLVD BLDG 1
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3477
Practice Address - Country:US
Practice Address - Phone:361-992-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX337691223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33769OtherTEXAS STATE DENTAL LICENSE