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General NPI Number Information
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NPI Number | 1437562972
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Entity Type | Individual
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Provider Name | MARY HANNA GHATTAS D.M.D
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Gender | Female
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Dates
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Enumeration Date | 06/03/2014
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Last Update Date | 08/09/2016
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Provider Practice Location Address
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Address Line | 1247 BEACON ST
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City | BROOKLINE
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State | MA
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Zip | 02446-5273
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Country | US
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Telephone | 617-738-0806
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 PRESIDENTS WAY APT 1319
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City | DEDHAM
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State | MA
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Zip | 02026-4568
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN1856582
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN1856582
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License Number State | MA
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