Healthcare Provider Details

I. General information

NPI: 1730380874
Provider Name (Legal Business Name): HUSHANG GHODRAT, DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 COLLEGE STREET SUITE B
OXFORD NC
27565
US

IV. Provider business mailing address

1419 COLLEGE STREET SUITE B
OXFORD NC
27565
US

V. Phone/Fax

Practice location:
  • Phone: 919-693-9755
  • Fax: 919-693-9067
Mailing address:
  • Phone: 919-693-9755
  • Fax: 919-693-9067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6984
License Number StateNC

VIII. Authorized Official

Name: JAMIE M. BRUMMITT
Title or Position: OFFICE MANAGER
Credential:
Phone: 919-693-9755