Provider Demographics
NPI:1316321557
Name:IBRAHIM, HAZHA (DDS)
Entity type:Individual
Prefix:
First Name:HAZHA
Middle Name:
Last Name:IBRAHIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 E MINERAL AVE APT 530
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4766
Mailing Address - Country:US
Mailing Address - Phone:720-548-4238
Mailing Address - Fax:
Practice Address - Street 1:5127 E BRIDGE ST STE B
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-8318
Practice Address - Country:US
Practice Address - Phone:720-548-4238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002025911223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry