MEDICARE: GHARRAPH,PC

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	29173	TX

General Provider Information

NPI Number	:	1982022745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GHARRAPH,PC

Provider Business Mailing Address
First Line	:	4609 GARDENIA WAY
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-7093
Country	:	US
Telephone Number	:	909-709-8822
Fax Number	:

Provider Business Practice Location Address
First Line	:	3851 SW GREEN OAK BLVD
Second Line	:	123
City	:	ARLINGTON
State	:	TX
Zip	:	76017-4130
Country	:	US
Telephone Number	:	817-483-2445
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	DR. HUSSAM M GHARRAPH
Credential	:	DDS
Telephone Number	:	909-709-8822

Provider Enumeration Date	:	03/30/2014
Last Update Date	:	03/30/2014

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