Healthcare Provider Details

I. General information

NPI: 1093497463
Provider Name (Legal Business Name): GEORGE EYAD IBRAHIM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 SOLANO AVE STE 309
BERKELEY CA
94707-2218
US

IV. Provider business mailing address

2242 KENRY WAY
S SAN FRAN CA
94080-5508
US

V. Phone/Fax

Practice location:
  • Phone: 510-527-9564
  • Fax:
Mailing address:
  • Phone: 650-773-3411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number109016
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: