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General NPI Number Information
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NPI Number | 1568269074
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Entity Type | Organization
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Legal Business Name | SANDY IBRAHIM DMD MS INC
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Dates
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Enumeration Date | 03/03/2025
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 1727 N RIVERSIDE AVE
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City | RIALTO
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State | CA
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Zip | 92376-8062
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Country | US
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Telephone | 909-961-2068
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Fax |
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Provider Business Mailing Address
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Address Line | 1727 N RIVERSIDE AVE
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City | RIALTO
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State | CA
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Zip | 92376-8062
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Country | US
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Telephone | 909-961-2068
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. SANDY N. IBRAHIM
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Credential | DMD MS
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Telephone | 626-893-1053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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