Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 0401007367 | VA |
NPI | 1013967942 |
---|---|
Provider Name | Dr. Greg M Zoghby |
First Address | Richmond, VA 23255-1930 |
Second Address | Midlothian, VA 23113-5604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 29/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V06172 | (02) | VA |