Provider Demographics
NPI:1386158673
Name:SAMIRAH, IBRAHEEM (DMD)
Entity type:Individual
Prefix:DR
First Name:IBRAHEEM
Middle Name:
Last Name:SAMIRAH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12502 DARDANELLE CT
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-5731
Mailing Address - Country:US
Mailing Address - Phone:202-492-0034
Mailing Address - Fax:
Practice Address - Street 1:1194 BIG BETHEL RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-1906
Practice Address - Country:US
Practice Address - Phone:757-690-0009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-22
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD165871223G0001X
VA04014168841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice