Active NPI
Ibrahim A Durra, DMD
- Pediatric Dentistry
- Havertown, PA
National Provider Identifier
1154310845
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DS035913L
- Practice address
- 1220 W Chester Pike
Havertown, PA 19083-3339 - Phone
- (484) 454-3230
- Fax
- (484) 455-7186
- NPI assigned
- Oct 17, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | DS035913L | PA | Primary |
Addresses
Primary practice location
1220 W Chester Pike
Havertown, PA 19083-3339
Mailing address
1220 W Chester Pike
Havertown, PA 19083-3339
Phone (484) 454-3230
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS035913L | PA | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Broomall Pediatric Dentistry & Orthodontics,P.C. | Pediatric Dentistry | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Pediatric Dentistry
- Havertown, PA
- NPI 1336202787
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129507200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1382659200000",
"number": "1154310845",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1220 W CHESTER PIKE",
"city": "HAVERTOWN",
"state": "PA",
"postal_code": "190833339",
"telephone_number": "484-454-3230",
"fax_number": "484-455-7186"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1220 W CHESTER PIKE",
"city": "HAVERTOWN",
"state": "PA",
"postal_code": "190833339",
"telephone_number": "484-454-3230",
"fax_number": "484-455-7186"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DURRA",
"first_name": "IBRAHIM",
"middle_name": "A",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-17",
"last_updated": "2013-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "PA",
"license": "DS035913L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Havertown, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.