Healthcare Provider Details

I. General information

NPI: 1457264574
Provider Name (Legal Business Name): IBRAHIM ZEITOUN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6325 E RUSSELL RD STE 100
LAS VEGAS NV
89122-7072
US

IV. Provider business mailing address

6452 JONATHON ST
DEARBORN MI
48126-2230
US

V. Phone/Fax

Practice location:
  • Phone: 313-797-1077
  • Fax:
Mailing address:
  • Phone: 313-797-1077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8459
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: