MEDICARE: HIVAND AND GHAZAL DENTAL CORPORATION

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

General Provider Information

NPI Number	:	1174618003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIVAND AND GHAZAL DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	2860 MICHELLE
Second Line	:	2ND FLOOR
City	:	IRVINE
State	:	CA
Zip	:	92606-1009
Country	:	US
Telephone Number	:	714-508-3600
Fax Number	:	714-368-2084

Provider Business Practice Location Address
First Line	:	68487 E PALM CANYON DR
Second Line	:	BLDG. 1
City	:	CATHEDRAL CITY
State	:	CA
Zip	:	92234-5434
Country	:	US
Telephone Number	:	760-328-6208
Fax Number	:	760-328-6169

Authorized Official
Title or Position	:	OWNER DDS
Name	:	DR. CAROLYN G. GHAZAL
Credential	:	DDS
Telephone Number	:	760-328-6208

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	06/12/2008

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