Individual
MARIAN HANNAH IBRAHIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
19189 W 12 MILE RD, LATHRUP VILLAGE, MI 48076
(248) 855-1855
Mailing address
7118 TIMBERVIEW TRL, WEST BLOOMFIELD, MI 48322-3343
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901600579
MI
Other
Enumeration date
07/09/2020
Last updated
07/09/2020
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