MEDICARE: GHAREEB AND GHAREEB, DDS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790990638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GHAREEB AND GHAREEB, DDS, PC

Provider Business Mailing Address
First Line	:	1203 JEFFERSON RD
Second Line	:
City	:	SOUTH CHARLESTON
State	:	WV
Zip	:	25309-9732
Country	:	US
Telephone Number	:	304-744-3333
Fax Number	:	304-744-8245

Provider Business Practice Location Address
First Line	:	1203 JEFFERSON RD
Second Line	:
City	:	SOUTH CHARLESTON
State	:	WV
Zip	:	25309-9732
Country	:	US
Telephone Number	:	304-744-3333
Fax Number	:	304-744-8245

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. STEVEN AMOS GHAREEB
Credential	:	DDS
Telephone Number	:	304-744-3333

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	08/09/2007

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