Individual
ISSAM GHABEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4210 SANSOM ST, PHILADELPHIA, PA 19104-3589
(614) 500-0304
Mailing address
4210 SANSOM ST APT 104, PHILADELPHIA, PA 19104-3589
(614) 500-0304
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS042785
PA
Other
Enumeration date
05/19/2020
Last updated
09/29/2020
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