Healthcare Provider Details

I. General information

NPI: 1073005278
Provider Name (Legal Business Name): MHD GHAYATH ALHALABI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3739 BATH PIKE
BETHLEHEM PA
18017
US

IV. Provider business mailing address

121 S 43RD ST APT 304
PHILADELPHIA PA
19104-3195
US

V. Phone/Fax

Practice location:
  • Phone: 610-317-2400
  • Fax:
Mailing address:
  • Phone: 267-881-1781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS041683
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS041683
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: