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General NPI Number Information
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NPI Number | 1265861801
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Entity Type | Individual
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Provider Name | GEORGE IBRAHIM D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/04/2013
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 678 W ARROW HWY
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City | SAN DIMAS
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State | CA
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Zip | 91773-2958
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Country | US
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Telephone | 909-643-8007
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Fax |
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Provider Business Mailing Address
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Address Line | 13272 WHISPERING CRK
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City | CHINO HILLS
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State | CA
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Zip | 91709-3592
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Country | US
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Telephone | 909-636-4534
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN1859150
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 62453
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License Number State | CA
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