MEDICARE: MARY HANNA GHATTAS D.M.D

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	1223P0221X	Pediatric Dentistry	DN1856582	MA
2	122300000X	Dentist	DN1856582	MA

General Provider Information

NPI Number	:	1437562972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY HANNA GHATTAS D.M.D

Provider Business Mailing Address
First Line	:	1000 PRESIDENTS WAY APT 1319
Second Line	:
City	:	DEDHAM
State	:	MA
Zip	:	02026-4568
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1247 BEACON ST
Second Line	:
City	:	BROOKLINE
State	:	MA
Zip	:	02446-5273
Country	:	US
Telephone Number	:	617-738-0806
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2014
Last Update Date	:	08/09/2016

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