MEDICARE: KYROLOS IBRAHIM

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	1223G0001X	General Practice Dentistry	DN10000258	MA

General Provider Information

NPI Number	:	1689415036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYROLOS IBRAHIM

Provider Business Mailing Address
First Line	:	20 WILLIAM ST STE G75
Second Line	:
City	:	WELLESLEY
State	:	MA
Zip	:	02481-4142
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 WILLIAM ST STE G75
Second Line	:
City	:	WELLESLEY
State	:	MA
Zip	:	02481-4142
Country	:	US
Telephone Number	:	781-235-9018
Fax Number	:

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

Provider Enumeration Date	:	05/31/2024
Last Update Date	:	01/11/2026

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Directions to “ KYROLOS IBRAHIM ” Practice Location

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