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General NPI Number Information
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NPI Number | 1013540871
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Entity Type | Individual
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Provider Name | AHMED GAMIL IBRAHEEM DDS, MSD
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Gender | Male
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Dates
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Enumeration Date | 02/19/2020
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Last Update Date | 07/21/2021
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Provider Practice Location Address
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Address Line | 1601 N TUCSON BLVD STE 12C
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City | TUCSON
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State | AZ
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Zip | 85716-3405
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Country | US
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Telephone | 520-200-5062
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Fax |
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Provider Business Mailing Address
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Address Line | 16450 W VAN BUREN ST APT 2029
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City | GOODYEAR
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State | AZ
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Zip | 85338-1610
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Country | US
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Telephone | 718-200-1428
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | D010935
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License Number State | AZ
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