Individual
IBRAHIM MASSOUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2743 S 6TH STREET, SPRINGFIELD, IL 62703
(217) 522-4121
(217) 522-7140
Mailing address
2743 S 6TH STREET, SPRINGFIELD, IL 62703
(217) 522-4121
(217) 522-7140
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
O19025844
IL
Other
Enumeration date
11/06/2006
Last updated
05/31/2013
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