Provider Demographics
NPI:1912134412
Name:MUBAREZ, GHADA A (DDS)
Entity Type:Individual
Prefix:DR
First Name:GHADA
Middle Name:A
Last Name:MUBAREZ
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 1:403 ANDERSON AVE
Mailing Address - Street 2:APT # 2A
Mailing Address - City:FAIRVIEW
Mailing Address - State:NJ
Mailing Address - Zip Code:07022-1146
Mailing Address - Country:US
Mailing Address - Phone:917-903-2591
Mailing Address - Fax:718-901-8121
Practice Address - Street 1:140 MARKET ST
Practice Address - Street 2:FLOOR 3
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-1471
Practice Address - Country:US
Practice Address - Phone:973-742-4200
Practice Address - Fax:973-742-4997
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DIO2394800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0289825Medicaid