Organization
IBRAHIM DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ENITAN CASSANDRA IBRAHIM DDS (PRESIDENT)
(661) 294-3700
Entity
Organization
Contact information
Practice address
25880 TOURNAMENT RD, SUITE 103, VALENCIA, CA 91355-2349
(661) 294-3700
(661) 294-9080
Mailing address
23642 LYONS AVE, #220465, NEWHALL, CA 91322-6001
(661) 294-3700
(661) 294-9080
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
50613
CA
Other
Enumeration date
12/09/2012
Last updated
12/09/2012
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