Provider Demographics
NPI:1952841017
Name:IKRAM, TAYEBA MINHAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:TAYEBA
Middle Name:MINHAS
Last Name:IKRAM
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 1:2003 ASHFORD DR
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:KY
Mailing Address - Zip Code:40026-8424
Mailing Address - Country:US
Mailing Address - Phone:812-989-3459
Mailing Address - Fax:
Practice Address - Street 1:60 STONECREST CT
Practice Address - Street 2:SUITE NUMBER 200
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-8155
Practice Address - Country:US
Practice Address - Phone:502-633-1819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9880122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist