MEDICARE: GEORGE GHALY, DDS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry
2	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1053516450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE GHALY, DDS, PC

Provider Business Mailing Address
First Line	:	201 BOSTON POST RD W STE 405A
Second Line	:
City	:	MARLBOROUGH
State	:	MA
Zip	:	01752-4667
Country	:	US
Telephone Number	:	508-366-1855
Fax Number	:	508-366-1855

Provider Business Practice Location Address
First Line	:	201 BOSTON POST RD W STE 405
Second Line	:
City	:	MARLBOROUGH
State	:	MA
Zip	:	01752-4667
Country	:	US
Telephone Number	:	508-366-1855
Fax Number	:	508-870-0544

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MRS. LILIAN GHALY
Credential	:
Telephone Number	:	508-366-1855

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	09/22/2023

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