Provider Demographics
NPI:1205244712
Name:GHOBRYAL, MENA (DDS)
Entity type:Individual
Prefix:
First Name:MENA
Middle Name:
Last Name:GHOBRYAL
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 1:730 24TH ST NW STE 9
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-2502
Mailing Address - Country:US
Mailing Address - Phone:202-333-9282
Mailing Address - Fax:
Practice Address - Street 1:730 24TH ST NW STE 9
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2502
Practice Address - Country:US
Practice Address - Phone:202-333-9282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1001283122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist