Healthcare Provider Details

I. General information

NPI: 1871938027
Provider Name (Legal Business Name): FERAS HASAN GHAZAL B.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3370 W 117TH ST
CLEVELAND OH
44111-3605
US

IV. Provider business mailing address

3370 W 117TH ST
CLEVELAND OH
44111-3605
US

V. Phone/Fax

Practice location:
  • Phone: 216-688-0900
  • Fax:
Mailing address:
  • Phone: 216-688-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.024624
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRES.3262
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: