Individual
IGOR IBRAGIMOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
12720 KANSAS AVE, FORT LEONARD WOOD, MO 65473
(573) 596-1470
Mailing address
12720 KANSAS AVE, FORT LEONARD WOOD, MO 65473
(573) 596-1470
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
00000000000000
UT
Other
Enumeration date
05/21/2024
Last updated
07/11/2024
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