Individual
MOHAMED IBRAHIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
18010 JEFFERSON DAVIS HIGHWAY, RUTHER GLEN, VA 22546
(804) 589-1491
Mailing address
154 HAVEN AVENUE APT #1202, NEW YORK, NY 10032
(703) 624-8188
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
041415899
VA
Other
Enumeration date
01/10/2018
Last updated
01/10/2018
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