Healthcare Provider Details

I. General information

NPI: 1477239788
Provider Name (Legal Business Name): AHMED RAMADAN IBRAHIM DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 06/22/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3907 E COLONIAL DR
ORLANDO FL
32803-5209
US

IV. Provider business mailing address

7263 HUNTERDON DR
ORLANDO FL
32835-6144
US

V. Phone/Fax

Practice location:
  • Phone: 407-228-0132
  • Fax:
Mailing address:
  • Phone: 407-285-8091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number28246
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: