MEDICARE: AMIRA A EL-DAIBANI 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	2025046766	MO

General Provider Information

NPI Number	:	1558108100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMIRA A EL-DAIBANI DMD

Provider Business Mailing Address
First Line	:	212 E MARKET ST
Second Line	:
City	:	TROY
State	:	IL
Zip	:	62294-1512
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1224 GRAHAM RD STE 2002
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-8026
Country	:	US
Telephone Number	:	314-673-2348
Fax Number	:

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

Provider Enumeration Date	:	07/11/2024
Last Update Date	:	12/22/2025

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