Provider Demographics
NPI:1881394591
Name:AL JEBAHJE, MARWAH BALASIM (DMD)
Entity type:Individual
Prefix:
First Name:MARWAH
Middle Name:BALASIM
Last Name:AL JEBAHJE
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 1:375 MOUNT VERNON ST APT 714
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-3162
Mailing Address - Country:US
Mailing Address - Phone:623-200-6867
Mailing Address - Fax:
Practice Address - Street 1:375 MOUNT VERNON ST APT 714
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02125-3162
Practice Address - Country:US
Practice Address - Phone:623-200-6867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18599771223G0001X
MI29016024461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral Practice