MEDICARE: DR. MOUAWIA GHIBA DMD

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	1223P0700X	Prosthodontics	20505	OH

General Provider Information

NPI Number	:	1932184199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOUAWIA GHIBA DMD

Provider Business Mailing Address
First Line	:	452 OAKMOOR RD
Second Line	:
City	:	BAY VILLAGE
State	:	OH
Zip	:	44140-2521
Country	:	US
Telephone Number	:	440-871-0948
Fax Number	:

Provider Business Practice Location Address
First Line	:	435 GRISWOLD RD
Second Line	:
City	:	ELYRIA
State	:	OH
Zip	:	44035-2304
Country	:	US
Telephone Number	:	440-871-0948
Fax Number	:	440-324-9454

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

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	07/08/2007

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