Active NPI
Rola Ghabrah, DENTIST
- Pediatric Dentistry
- Roxbury, MA
National Provider Identifier
1124791447
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DL100663
- Practice address
- 45 Dimock St
Roxbury, MA 02119-1208 - Phone
- (617) 442-8800
- Fax
- (617) 442-4088
- NPI assigned
- Aug 2, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatric Dentistry | 1223P0221X | DL100663 | MA | Primary |
Addresses
Primary practice location
45 Dimock St
Roxbury, MA 02119-1208
Mailing address
55 Dimock Street
Roxbury, MA 02119-1029
Phone (617) 442-8800
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241016001384 | MA | Practitioner - Dentist | 3476085416 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DL100663 | MA | MD | Pediatric Dentist |
| DL16021 | MA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1627862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1740614400000",
"number": "1124791447",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 DIMOCK STREET",
"city": "ROXBURY",
"state": "MA",
"postal_code": "021191029",
"telephone_number": "617-442-8800",
"fax_number": "617-442-4088"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "45 DIMOCK ST",
"city": "ROXBURY",
"state": "MA",
"postal_code": "021191208",
"telephone_number": "617-442-8800",
"fax_number": "617-442-4088"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GHABRAH",
"first_name": "ROLA",
"credential": "DENTIST",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-08-02",
"last_updated": "2025-02-27",
"certification_date": "2025-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "MA",
"license": "DL100663",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roxbury, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.