Provider Demographics
NPI:1548653363
Name:GHATALA, AMINA PEERAN (DDS)
Entity type:Individual
Prefix:DR
First Name:AMINA
Middle Name:PEERAN
Last Name:GHATALA
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 1:6 MORLEY CT
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1138
Mailing Address - Country:US
Mailing Address - Phone:917-698-5066
Mailing Address - Fax:
Practice Address - Street 1:6 MORLEY CT
Practice Address - Street 2:
Practice Address - City:ALBERTSON
Practice Address - State:NY
Practice Address - Zip Code:11507-1138
Practice Address - Country:US
Practice Address - Phone:917-698-5066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-18
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0592171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice