Provider Demographics
NPI:1467676866
Name:EHAB F. ISMAIL,INC
Entity Type:Organization
Organization Name:EHAB F. ISMAIL,INC
Other - Org Name:EHAB ISMAIL,D.D.S
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EHAB
Authorized Official - Middle Name:F
Authorized Official - Last Name:ISMAIL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-644-2310
Mailing Address - Street 1:13637 HAWTHORNE BLVD,
Mailing Address - Street 2:SUITE #101
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250
Mailing Address - Country:US
Mailing Address - Phone:310-644-2310
Mailing Address - Fax:
Practice Address - Street 1:13637 HAWTHORNE BLVD
Practice Address - Street 2:SUITE #101
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-5812
Practice Address - Country:US
Practice Address - Phone:310-644-2310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA471021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty