Provider Demographics
NPI:1962609628
Name:GHALLOUB, MELAD NAJI (DMD)
Entity type:Individual
Prefix:
First Name:MELAD
Middle Name:NAJI
Last Name:GHALLOUB
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 1:7000 W CAMINO REAL
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-5532
Mailing Address - Country:US
Mailing Address - Phone:561-347-5002
Mailing Address - Fax:561-347-5020
Practice Address - Street 1:7000 W CAMINO REAL
Practice Address - Street 2:SUITE 130
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5532
Practice Address - Country:US
Practice Address - Phone:561-347-5002
Practice Address - Fax:561-347-5020
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 16343122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist