Provider Demographics
NPI:1396974341
Name:IBRAHIM-SMILEKEEPERS DENTAL
Entity type:Organization
Organization Name:IBRAHIM-SMILEKEEPERS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ESSAM
Authorized Official - Middle Name:N
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-766-2221
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-0550
Mailing Address - Country:US
Mailing Address - Phone:410-766-2221
Mailing Address - Fax:
Practice Address - Street 1:7954 BALTIMORE ANNAPOLIS BLVD
Practice Address - Street 2:SUITE 1-C
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-8188
Practice Address - Country:US
Practice Address - Phone:410-766-2221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11627122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty