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General NPI Number Information
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NPI Number | 1316788805
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Entity Type | Individual
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Provider Name | IBRAHIM M ALWAN DDS
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Gender | Male
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Dates
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Enumeration Date | 06/06/2024
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | W183N9609 APPLETON AVE
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City | GERMANTOWN
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State | WI
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Zip | 53022-4501
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Country | US
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Telephone | 262-677-3700
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Fax |
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Provider Business Mailing Address
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Address Line | 650 WINTHROP AVE
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City | GLENDALE HEIGHTS
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State | IL
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Zip | 60139-2975
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Country | US
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Telephone |
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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 | 600153615
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019035197
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License Number State | IL
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