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General NPI Number Information
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NPI Number | 1801067293
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Entity Type | Individual
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Provider Name | MAZEN S. GHATTAS DMD
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Gender | Male
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Dates
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Enumeration Date | 03/13/2008
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Last Update Date | 05/08/2012
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Provider Practice Location Address
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Address Line | 4061 BELLAIRE BLVD SUITE C
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City | HOUSTON
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State | TX
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Zip | 77025-1121
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Country | US
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Telephone | 713-664-1337
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Fax |
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Provider Business Mailing Address
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Address Line | 42 CHERRY HLS
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City | JERSEY VILLAGE
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State | TX
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Zip | 77064-4072
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Country | US
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Telephone | 832-294-8123
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 18607
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License Number State | MA
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