Provider Demographics
NPI:1861408197
Name:MASSABNI, GHADA SOUHEL (DMD)
Entity type:Individual
Prefix:
First Name:GHADA
Middle Name:SOUHEL
Last Name:MASSABNI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 MAIN ST
Mailing Address - Street 2:GHADA S MASSABNI DMD DDS
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801
Mailing Address - Country:US
Mailing Address - Phone:781-935-2200
Mailing Address - Fax:781-933-1999
Practice Address - Street 1:576 MAIN ST
Practice Address - Street 2:GHADA S MASSABNI DMD DDS
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801
Practice Address - Country:US
Practice Address - Phone:781-935-2200
Practice Address - Fax:781-933-1999
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA182661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice