Healthcare Provider Details

I. General information

NPI: 1053516450
Provider Name (Legal Business Name): GEORGE GHALY, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 BOSTON POST RD W STE 405
MARLBOROUGH MA
01752-4667
US

IV. Provider business mailing address

201 BOSTON POST RD W STE 405A
MARLBOROUGH MA
01752-4667
US

V. Phone/Fax

Practice location:
  • Phone: 508-366-1855
  • Fax: 508-870-0544
Mailing address:
  • Phone: 508-366-1855
  • Fax: 508-366-1855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. LILIAN GHALY
Title or Position: BUSINESS MANAGER
Credential:
Phone: 508-366-1855