Provider Demographics
NPI:1548386121
Name:EBRAHIM, SHAYHANA (DMD)
Entity Type:Individual
Prefix:
First Name:SHAYHANA
Middle Name:
Last Name:EBRAHIM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4577 BRIGHTON CIR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7343
Mailing Address - Country:US
Mailing Address - Phone:810-953-9738
Mailing Address - Fax:
Practice Address - Street 1:G4007 W COURT ST
Practice Address - Street 2:SUITE D
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3560
Practice Address - Country:US
Practice Address - Phone:810-230-0077
Practice Address - Fax:810-720-1306
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI09191831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice