Provider Demographics
NPI:1003541368
Name:JFOUF IBRAHIM, RONY (DDS)
Entity type:Individual
Prefix:
First Name:RONY
Middle Name:
Last Name:JFOUF IBRAHIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 ANNAPOLIS CIR
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-3678
Mailing Address - Country:US
Mailing Address - Phone:931-591-8331
Mailing Address - Fax:
Practice Address - Street 1:4730 LEBANON PIKE STE 101
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1313
Practice Address - Country:US
Practice Address - Phone:615-219-5722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11963122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist