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NPI Code Detail

MEDICARE: IBRAHIM IDOH DENTAL HYGIENE

MEDICARE: IBRAHIM IDOH DENTAL HYGIENE
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
1126800000XDental Assistant

General Provider Information

NPI Number : 1255299368
Entity Type Code : Individual
Provider Name (Legal Business Name) : IBRAHIM IDOH DENTAL HYGIENE
Provider Business Mailing Address
First Line : 7223 MISSISSIPPI AVENUE
Second Line : BLDG 1561
City : FORT POLK
State : LA
Zip : 71459-7435
Country : US
Telephone Number : 726-780-1451
Fax Number :
Provider Business Practice Location Address
First Line : 7223 MISSISSIPPI AVENUE
Second Line : BLDG 1561
City : FORT POLK
State : LA
Zip : 71459-7435
Country : US
Telephone Number : 726-780-1451
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2026
Last Update Date : 01/15/2026

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Directions to “ IBRAHIM IDOH DENTAL HYGIENE” Practice Location

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