# MOSTAFA IBRAHIM

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1336818665
- **Gender:** Man
- **Credential:** BDS,PROSTHODONTIST

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 019033395 | IL | Yes |
| 122300000X | Dentist | 2901601119 | MI | — |

## Other

- **Enumeration date:** 09/09/2021
- **Last updated:** 09/09/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 019033395 | — | IL |
| 05 | — | 2901601119APP21 | — | MI |