Healthcare Provider Details

I. General information

NPI: 1932184199
Provider Name (Legal Business Name): MOUAWIA GHIBA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 GRISWOLD RD
ELYRIA OH
44035-2304
US

IV. Provider business mailing address

452 OAKMOOR RD
BAY VILLAGE OH
44140-2521
US

V. Phone/Fax

Practice location:
  • Phone: 440-871-0948
  • Fax: 440-324-9454
Mailing address:
  • Phone: 440-871-0948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number20505
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: