Individual
DR. HUSHANG GHODRAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
560 DABNEY DRIVE, SUITE C, HENDERSON, NC 27536-5919
(252) 492-1938
Mailing address
560 DABNEY DRIVE, SUITE C, HENDERSON, NC 27536
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6984
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011G5
BCBS PROVIDER #
NC
01
—
6984
DELTA DENTAL PROVIDER #
NC
05
—
8990121
—
NC
Enumeration date
06/20/2006
Last updated
07/09/2007
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