Provider Demographics
NPI:1194254847
Name:DAWOOD, IBRAHIM (DDS)
Entity type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:
Last Name:DAWOOD
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 1:11820 SEATON DR APT F4
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-5094
Mailing Address - Country:US
Mailing Address - Phone:616-419-9250
Mailing Address - Fax:
Practice Address - Street 1:50503 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-3184
Practice Address - Country:US
Practice Address - Phone:586-684-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010222421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice