Provider Demographics
NPI:1902598675
Name:IBRAHIM, ALI ABDALLAH (DDS)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:ABDALLAH
Last Name:IBRAHIM
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 1:522 WHEELING AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-2250
Mailing Address - Country:US
Mailing Address - Phone:313-626-3514
Mailing Address - Fax:
Practice Address - Street 1:522 WHEELING AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-2250
Practice Address - Country:US
Practice Address - Phone:313-626-3514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1223G0001X1223G0001X
OH30027761122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice