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General NPI Number Information
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NPI Number | 1750550315
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Entity Type | Organization
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Legal Business Name | NEDDA I. IBRAHIM, DDS
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Dates
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Enumeration Date | 02/27/2008
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Last Update Date | 02/27/2008
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Provider Practice Location Address
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Address Line | 1009 DRESSER CT
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City | RALEIGH
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State | NC
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Zip | 27609-7323
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Country | US
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Telephone | 919-873-1313
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Fax | 919-873-1323
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Provider Business Mailing Address
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Address Line | 1009 DRESSER CT
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City | RALEIGH
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State | NC
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Zip | 27609-7323
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Country | US
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Telephone | 919-873-1313
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Fax | 919-873-1323
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Authorized Official
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Title or Position | MANAGER
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Name | MR. MATTHEW DRABICK
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Credential |
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Telephone | 919-873-1313
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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 | 5920
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License Number State | NC
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