Provider Demographics
NPI:1073526117
Name:IBRAHIM, NABIL RENE (BDS, DDS)
Entity Type:Individual
Prefix:DR
First Name:NABIL
Middle Name:RENE
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:BDS, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CONVERSE PL STE 102
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-2713
Mailing Address - Country:US
Mailing Address - Phone:781-729-1159
Mailing Address - Fax:781-756-0900
Practice Address - Street 1:10 CONVERSE PL
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890
Practice Address - Country:US
Practice Address - Phone:781-729-1159
Practice Address - Fax:781-756-0900
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA196681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice