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General NPI Number Information
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NPI Number | 1740320480
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Entity Type | Individual
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Provider Name | DR. AYMAN GHOZLAN
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Gender | Male
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 10/18/2010
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Provider Practice Location Address
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Address Line | 1745 W KETTLEMAN LN B
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City | LODI
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State | CA
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Zip | 95242-9287
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Country | US
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Telephone | 916-337-1077
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Fax | 916-897-2567
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Provider Business Mailing Address
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Address Line | 10374 STATHOS DR
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City | ELK GROVE
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State | CA
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Zip | 95757-1609
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Country | US
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Telephone | 916-337-1077
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Fax | 916-897-2567
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 46060
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License Number State | CA
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