Provider Demographics
NPI:1386487692
Name:GHRAIEB, ROMEO (DMD)
Entity type:Individual
Prefix:
First Name:ROMEO
Middle Name:
Last Name:GHRAIEB
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 PONTIAC AVE APT 12203
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-5938
Mailing Address - Country:US
Mailing Address - Phone:401-497-7489
Mailing Address - Fax:
Practice Address - Street 1:4995 S COUNTY TRL
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:RI
Practice Address - Zip Code:02813-3182
Practice Address - Country:US
Practice Address - Phone:401-364-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN037301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice