Provider Demographics
NPI:1386289767
Name:GHARBI, NAZGOL (DDS)
Entity type:Individual
Prefix:DR
First Name:NAZGOL
Middle Name:
Last Name:GHARBI
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 1:5310 BURNET RD STE 108
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-2061
Mailing Address - Country:US
Mailing Address - Phone:512-458-5999
Mailing Address - Fax:
Practice Address - Street 1:5310 BURNET RD STE 108
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-2061
Practice Address - Country:US
Practice Address - Phone:512-458-5999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-09
Last Update Date:2019-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX357951223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health