Provider Demographics
NPI:1154310845
Name:DURRA, IBRAHIM A (DMD)
Entity Type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:A
Last Name:DURRA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 W CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-3339
Mailing Address - Country:US
Mailing Address - Phone:484-454-3230
Mailing Address - Fax:484-455-7186
Practice Address - Street 1:1220 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-3339
Practice Address - Country:US
Practice Address - Phone:484-454-3230
Practice Address - Fax:484-455-7186
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS035913L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry