MEDICARE: DR. IBTISAM AL-HASHIMI BDS, MS, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	F-21792	TX

General Provider Information

NPI Number	:	1174734693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IBTISAM AL-HASHIMI BDS, MS, PHD

Provider Business Mailing Address
First Line	:	PO BOX 845347
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-5347
Country	:	US
Telephone Number	:	469-291-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	6333 FOREST PARK
Second Line	:	SUITE 130
City	:	DALLAS
State	:	TX
Zip	:	75390-9109
Country	:	US
Telephone Number	:	214-645-3999
Fax Number	:	214-645-3989

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	02/28/2017

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