Provider Demographics
NPI:1902965940
Name:GHARRAPH, HUSSAM (DDS)
Entity Type:Individual
Prefix:
First Name:HUSSAM
Middle Name:
Last Name:GHARRAPH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:878 FRANK SMITH RD
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-2902
Mailing Address - Country:US
Mailing Address - Phone:909-709-8822
Mailing Address - Fax:
Practice Address - Street 1:878 FRANK SMITH RD
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-2902
Practice Address - Country:US
Practice Address - Phone:909-709-8822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291731223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry