NPIMap

Organization Active NPI

Mitri a. Ghareeb, DDS, PC

  • Dentist
  • Cross Lanes, WV
National Provider Identifier
1083853683
Registry record updated May 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
3713 Issued in WV
Legal business name
MITRI A. GHAREEB, DDS, PC
Practice address
5480 Big Tyler Road
Suite 1
Cross Lanes, WV 25313
Phone
(304) 776-1212
Fax
(304) 776-4542
NPI assigned
Feb 5, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mitri Alberto Ghareeb, DDSNPI 1821165812
Title
President
Phone
(304) 776-4541

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 3713 WV Primary

Addresses

Primary practice location

5480 Big Tyler Road
Suite 1
Cross Lanes, WV 25313

Mailing address

5480 Big Tyler Road
Suite 1
Cross Lanes, WV 25313
Phone (304) 776-1212

National Provider Directory

National Provider Directory

Locations

5480 Big Tyler Rd
Ste 1
Cross Lanes, WV 25313
Phone (304) 776-1212

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1233792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464220800000",
    "number": "1083853683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5480 BIG TYLER ROAD",
            "address_2": "SUITE 1",
            "city": "CROSS LANES",
            "state": "WV",
            "postal_code": "25313",
            "telephone_number": "304-776-1212",
            "fax_number": "304-776-4542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5480 BIG TYLER ROAD",
            "address_2": "SUITE 1",
            "city": "CROSS LANES",
            "state": "WV",
            "postal_code": "25313",
            "telephone_number": "304-776-1212",
            "fax_number": "304-776-4542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MITRI A. GHAREEB, DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-05",
        "last_updated": "2016-05-26",
        "status": "A",
        "authorized_official_last_name": "GHAREEB",
        "authorized_official_first_name": "MITRI",
        "authorized_official_middle_name": "ALBERTO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-776-4541",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "WV",
            "license": "3713",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cross Lanes, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.