Healthcare Provider Details

I. General information

NPI: 1548153836
Provider Name (Legal Business Name): DAVID IBRAHIM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8412 JOHN F KENNEDY BLVD
NORTH BERGEN NJ
07047-4265
US

IV. Provider business mailing address

5 UNAMI LN
SCOTCH PLAINS NJ
07076-2933
US

V. Phone/Fax

Practice location:
  • Phone: 551-208-3279
  • Fax:
Mailing address:
  • Phone: 551-208-3279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI03118500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: