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Organization
MAISY IBRAHIM DENTAL CORPORATION
Active
Organization
MAISY IBRAHIM DENTAL CORPORATION
Active
Other names
Desert Dental Spa
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAISY S IBRAHIM DDS, DMD,DSM (OWNER)
(760) 340-0303
Entity
Organization
Contact information
Practice address
41990 COOK ST, SUITE D402, PALM DESERT, CA 92211-6100
(760) 340-0303
(760) 346-2304
Mailing address
41990 COOK ST, SUITE D402, PALM DESERT, CA 92211-6100
(760) 340-0303
(760) 346-2304
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
43447
CA
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
06/04/2012
Last updated
06/22/2015
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