Provider Demographics
NPI:1619225786
Name:HAMADA-IBRAHIM, AHMED M (DMD)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:M
Last Name:HAMADA-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 1:32 TREMONT SYTREET
Mailing Address - Street 2:CITIDENTAL
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108
Mailing Address - Country:US
Mailing Address - Phone:617-681-4188
Mailing Address - Fax:
Practice Address - Street 1:32 TREMONT SYTREET
Practice Address - Street 2:CITIDENTAL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108
Practice Address - Country:US
Practice Address - Phone:617-681-4188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10844122300000X
MADN1856178122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist