Provider Demographics
NPI:1932242682
Name:YASSEIN, IBRAHEIM (DDS)
Entity Type:Individual
Prefix:
First Name:IBRAHEIM
Middle Name:
Last Name:YASSEIN
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 1:426 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07502-1927
Mailing Address - Country:US
Mailing Address - Phone:973-595-8083
Mailing Address - Fax:973-595-7940
Practice Address - Street 1:426 UNION AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07502-1927
Practice Address - Country:US
Practice Address - Phone:973-595-8083
Practice Address - Fax:973-595-7940
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI019497001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7436700Medicaid