Provider Demographics
NPI:1205999828
Name:GHRAIR, SUZAN BSHARA (DDS)
Entity type:Individual
Prefix:
First Name:SUZAN
Middle Name:BSHARA
Last Name:GHRAIR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 N MYERS ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2115
Mailing Address - Country:US
Mailing Address - Phone:818-848-8529
Mailing Address - Fax:818-848-8529
Practice Address - Street 1:349 N MYERS ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2115
Practice Address - Country:US
Practice Address - Phone:818-848-8529
Practice Address - Fax:818-848-8529
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2008-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43158122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist