MEDICARE: GHINA MORAD, DMD, A PROFESSIONAL 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	49149	CA

General Provider Information

NPI Number	:	1962428359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GHINA MORAD, DMD, A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	2920 BROADWAY
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94062-1578
Country	:	US
Telephone Number	:	650-592-6396
Fax Number	:	650-592-6421

Provider Business Practice Location Address
First Line	:	2920 BROADWAY
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94062-1578
Country	:	US
Telephone Number	:	650-592-6396
Fax Number	:	650-592-6421

Authorized Official
Title or Position	:	PRESIDENT & OFFICER
Name	:	DR. GHINA MORAD
Credential	:	DMD
Telephone Number	:	650-592-6396

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	04/04/2024

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