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NPI Code Detail

MEDICARE: DR. ESSAM NAGUIB IBRAHIM D.M.D.

MEDICARE:  DR. ESSAM NAGUIB IBRAHIM  D.M.D.
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
1122300000XDentist11627MD
21223G0001XGeneral Practice DentistryDS041064PA

General Provider Information

NPI Number : 1336139625
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ESSAM NAGUIB IBRAHIM D.M.D.
Provider Business Mailing Address
First Line : 403 S JULIANA ST
Second Line :
City : BEDFORD
State : PA
Zip : 15522-1825
Country : US
Telephone Number : 814-623-8747
Fax Number : 814-623-7422
Provider Business Practice Location Address
First Line : 403 S JULIANA ST
Second Line :
City : BEDFORD
State : PA
Zip : 15522-1825
Country : US
Telephone Number : 814-623-8747
Fax Number : 814-623-7422
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2005
Last Update Date : 11/10/2016

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