Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DL14112 | MA |
NPI | 1003461849 |
---|---|
Provider Name | Hisham Joseph Gharib |
First Address | Arlington Heights, IL 60005-1500 |
Second Address | Arlington Heights, IL 60005-1500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2019 |
Last Update Date | 04/11/2021 |