MEDICARE: DR. PETER IBRAHIM DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN27081	FL

General Provider Information

NPI Number	:	1255074373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER IBRAHIM DMD

Provider Business Mailing Address
First Line	:	737 STIRLING CENTER PL STE 1801
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5715
Country	:	US
Telephone Number	:	407-805-8808
Fax Number	:

Provider Business Practice Location Address
First Line	:	737 STIRLING CENTER PL STE 1801
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5715
Country	:	US
Telephone Number	:	407-805-8808
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2022
Last Update Date	:	03/31/2026

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