Provider Demographics
NPI:1659443869
Name:GHAZI, GHAZWAN (DMD)
Entity type:Individual
Prefix:DR
First Name:GHAZWAN
Middle Name:
Last Name:GHAZI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-3032
Mailing Address - Country:US
Mailing Address - Phone:781-828-1788
Mailing Address - Fax:781-828-2788
Practice Address - Street 1:608 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-3032
Practice Address - Country:US
Practice Address - Phone:781-828-1788
Practice Address - Fax:781-828-2788
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA182651223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics