Provider Demographics
NPI:1285915421
Name:GHATTAS, MAUREEN BISHAY (DMD)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:BISHAY
Last Name:GHATTAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:BISHAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12500 E 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-3500
Mailing Address - Country:US
Mailing Address - Phone:586-573-6677
Mailing Address - Fax:
Practice Address - Street 1:12500 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3500
Practice Address - Country:US
Practice Address - Phone:586-573-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19543122300000X
MI2901020552122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist