Healthcare Provider Details

I. General information

NPI: 1447744966
Provider Name (Legal Business Name): GHAZAL NAVAB DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 05/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1242 E MAIN ST
EL CAJON CA
92021-7205
US

IV. Provider business mailing address

1242 E MAIN ST
EL CAJON CA
92021-7205
US

V. Phone/Fax

Practice location:
  • Phone: 619-444-6355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number102521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: