Ahmed Gamil Ibraheem, DDS, MSD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

D010935 Issued in AZ

Practice address

1601 N Tucson Blvd Ste 12C
Tucson, AZ 85716-3405

Phone

(520) 200-5062

NPI assigned

Feb 19, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Periodontal Associates of South Bend

  • Periodontics
  • South Bend, IN
  • NPI 1962078642
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1582070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626825600000",
    "number": "1013540871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16450 W VAN BUREN ST APT 2029",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853381610",
            "telephone_number": "718-200-1428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 N TUCSON BLVD STE 12C",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857163405",
            "telephone_number": "520-200-5062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBRAHEEM",
        "first_name": "AHMED",
        "middle_name": "GAMIL",
        "name_prefix": "Dr.",
        "credential": "DDS, MSD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-02-19",
        "last_updated": "2021-07-21",
        "certification_date": "2021-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "AZ",
            "license": "D010935",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ias Arizona PLLC
• Angela Ibarra, LMT
• Monica L Ibarra, RN
• Valerie Ibarra
• Jazmine Ibison
• Hesham Adam Ibrahim
• Mohab M Ibrahim, MD., PH.D.
• Nasir Adam Ibrahim
• Saamia Ibrahim
• Samir Jamal Ibrahim, MD

• Periodontics in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Periodontics in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.