NPIMap

Organization Active NPI

Ghozlan Dental Corp.

  • Dental Clinic/Center
  • Lodi, CA
National Provider Identifier
1447430624
Registry record updated Nov 6, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
46060 Issued in CA
Legal business name
GHOZLAN DENTAL CORP.
Practice address
1745 W Kettleman LN
Suite B
Lodi, CA 95242-9287
Phone
(209) 367-0700
Fax
(209) 367-0717
NPI assigned
Nov 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2007

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

Authorized official

Name
Ayman Mahmoud Ghozlan, DDSNPI 1740320480
Title
Dentist
Phone
(916) 337-1077

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
Dental Clinic/Center 261QD0000X 46060 CA Primary

Addresses

Primary practice location

1745 W Kettleman LN
Suite B
Lodi, CA 95242-9287

Mailing address

1745 W Kettleman LN
Suite B
Lodi, CA 95242-9287
Phone (209) 367-0700

National Provider Directory

National Provider Directory

Locations

1745 W Kettleman Ln
Ste B
Lodi, CA 95242
Phone (209) 367-0700

Practitioners & affiliated clinicians

Practitioners 1

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": "1194307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194307200000",
    "number": "1447430624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1745 W KETTLEMAN LN",
            "address_2": "SUITE B",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952429287",
            "telephone_number": "209-367-0700",
            "fax_number": "209-367-0717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1745 W KETTLEMAN LN",
            "address_2": "SUITE B",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952429287",
            "telephone_number": "209-367-0700",
            "fax_number": "209-367-0717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GHOZLAN DENTAL CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-06",
        "last_updated": "2007-11-06",
        "status": "A",
        "authorized_official_last_name": "GHOZLAN",
        "authorized_official_first_name": "AYMAN",
        "authorized_official_middle_name": "MAHMOUD",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "916-337-1077",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CA",
            "license": "46060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lodi, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2007; 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.