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General NPI Number Information
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NPI Number | 1437891579
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Entity Type | Individual
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Provider Name | SORA IBRAHEM OBEAD DDS
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Gender | Female
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Dates
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Enumeration Date | 04/09/2022
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 56625 VAN DYKE AVE
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48316-5025
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Country | US
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Telephone | 810-379-9545
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Fax | 810-243-0454
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Provider Business Mailing Address
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Address Line | 4071 LEE RD STE 260
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City | CLEVELAND
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State | OH
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Zip | 44128-2173
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Country | US
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Telephone | 313-587-9613
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901602258
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License Number State | MI
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