Maryam Ghorbani, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2024026698 Issued in MO

Practice address

40 Waterside PLZ Apt 12B
New York, NY 10010-2636

Phone

(760) 666-5066

NPI assigned

Aug 9, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1596931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734048000000",
    "number": "1104436690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 564",
            "city": "SAN MARCOS",
            "state": "CA",
            "postal_code": "920790564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 WATERSIDE PLZ APT 12B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100102636",
            "telephone_number": "760-666-5066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHORBANI",
        "first_name": "MARYAM",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-09",
        "last_updated": "2024-12-13",
        "certification_date": "2024-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "105212",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2024026698",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Gholston, LCSW-R
• Azar Ghomiboujaran, DDS
• Sara Ghoneim
• Rania Ghorab, PHARMD
• George Ryan Ghorayeb
• Hina Z Ghory, M.D.
• Mila Ghose, LCSW
• Arnab Ghosh, M.D., PH.D.
• Arnab Kumar Ghosh, MD
• Gaurav Ghosh, M.D.

• General Practice Dentistry in New York, NY
• Providers in New York, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2024; 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.