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General NPI Number Information
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NPI Number | 1659582187
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Entity Type | Organization
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Legal Business Name | HUSHANG GHODRAT DDS, PA
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 2552 CAPITOL DR SUITE 101
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City | CREEDMOOR
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State | NC
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Zip | 27522-9451
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Country | US
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Telephone | 919-528-9500
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Fax | 919-528-9556
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Provider Business Mailing Address
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Address Line | 2552 CAPITOL DR SUITE 101
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City | CREEDMOOR
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State | NC
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Zip | 27522-9451
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Country | US
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Telephone | 919-528-9500
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Fax | 919-528-9556
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Authorized Official
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Title or Position | OFFICE MANGAER
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Name | JAMIE M. BRUMMITT
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Credential |
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Telephone | 919-528-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6984
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License Number State | NC
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