Healthcare Provider Details

I. General information

NPI: 1093846974
Provider Name (Legal Business Name): MONA RIZK IBRAHIM DDS, MPH, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DETROIT HEALTH DEPT. - HERMAN KIEFER HEALTH COMPLEX 1151 TAYLOR STREET, 7TH FLOOR PEDIATRIC DENTAL CLINIC
DETROIT MI
48202-1732
US

IV. Provider business mailing address

DETROIT HEALTH DEPT. - HERMAN KIEFER HEALTH COMPLEX 1151 TAYLOR STREET, 7TH FLOOR PEDIATRIC DENTAL CLINIC
DETROIT MI
48202-1732
US

V. Phone/Fax

Practice location:
  • Phone: 313-876-4087
  • Fax: 313-871-1589
Mailing address:
  • Phone: 313-876-4087
  • Fax: 313-871-1589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: