Provider Demographics
NPI:1467975243
Name:IBRAHIM, MAGDI (DMD)
Entity Type:Individual
Prefix:DR
First Name:MAGDI
Middle Name:
Last Name:IBRAHIM
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 1:5916 W 88TH PL
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-1105
Mailing Address - Country:US
Mailing Address - Phone:708-529-3535
Mailing Address - Fax:
Practice Address - Street 1:7236 W 87TH ST
Practice Address - Street 2:
Practice Address - City:BRIDEVIEW
Practice Address - State:IL
Practice Address - Zip Code:60455
Practice Address - Country:US
Practice Address - Phone:708-415-8943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-24
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0311551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice