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General NPI Number Information
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NPI Number | 1104243674
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Entity Type | Organization
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Legal Business Name | WINTER STREET DENTAL GROUP
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Dates
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Enumeration Date | 03/24/2014
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Last Update Date | 03/24/2014
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Provider Practice Location Address
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Address Line | 188 WINTER ST
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City | HYANNIS
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State | MA
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Zip | 02601-2958
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Country | US
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Telephone | 508-771-3887
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Fax | 508-778-0845
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Provider Business Mailing Address
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Address Line | 188 WINTER ST
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City | HYANNIS
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State | MA
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Zip | 02601-2958
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Country | US
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Telephone | 508-771-3887
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Fax | 508-778-0845
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. GHAZWAN F. GHAZI
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Credential | D.D.S.
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Telephone | 508-771-3887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 18265
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License Number State | MA
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