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General NPI Number Information
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NPI Number | 1093055980
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Entity Type | Organization
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Legal Business Name | IBRAHIM IRAWAN DDS
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Dates
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Enumeration Date | 02/28/2013
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Last Update Date | 12/05/2014
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Provider Practice Location Address
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Address Line | 505 E ARROW HWY
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City | GLENDORA
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State | CA
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Zip | 91740-6034
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Country | US
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Telephone | 626-335-2899
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Fax |
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Provider Business Mailing Address
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Address Line | 505 E ARROW HWY
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City | GLENDORA
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State | CA
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Zip | 91740-6034
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Country | US
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Telephone | 626-335-2899
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Fax | 626-335-3892
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Authorized Official
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Title or Position | OWNER
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Name | DR. IBRAHIM IRAWAN
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Credential |
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Telephone | 626-335-2899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 37119
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License Number State | CA
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