Provider Demographics
NPI:1508745019
Name:IBRAGIMOVA, GULMIRA
Entity type:Individual
Prefix:
First Name:GULMIRA
Middle Name:
Last Name:IBRAGIMOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13931 SENECA RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-1667
Mailing Address - Country:US
Mailing Address - Phone:240-291-3711
Mailing Address - Fax:
Practice Address - Street 1:11151 ROBINWOOD DR
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6703
Practice Address - Country:US
Practice Address - Phone:240-291-3711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-28
Last Update Date:2025-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9221124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist