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NPI Code Detail

MEDICARE: GHALI GHALI, DDS PROFESSINAL LLC

MEDICARE: GHALI GHALI, DDS PROFESSINAL LLC
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
1261QD0000XDental Clinic/Center4998LA

General Provider Information

NPI Number : 1265974133
Entity Type Code : Organization
Provider Name (Legal Business Name) : GHALI GHALI, DDS PROFESSINAL LLC
Provider Business Mailing Address
First Line : 6513 PERKINS RD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70808-4259
Country : US
Telephone Number : 504-641-4888
Fax Number :
Provider Business Practice Location Address
First Line : 2409 SPORTSMAN DR
Second Line :
City : PHENIX CITY
State : AL
Zip : 36867-5402
Country : US
Telephone Number : 504-641-4888
Fax Number :
Authorized Official
Title or Position : OWNER/ DDS
Name : DR. GE GHALI
Credential : DDS,MD,FACS,FRCS
Telephone Number : 504-641-4888
Provider Enumeration Date : 11/09/2016
Last Update Date : 11/09/2016

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