Provider Demographics
NPI:1528447588
Name:GHOSN, CHARBEL (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARBEL
Middle Name:
Last Name:GHOSN
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 1:8057 BREWERTON RD
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-9585
Mailing Address - Country:US
Mailing Address - Phone:347-400-9566
Mailing Address - Fax:
Practice Address - Street 1:8057 BREWERTON RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-9585
Practice Address - Country:US
Practice Address - Phone:347-400-9566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-23
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058719122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist