Active NPI
Carolin Ibrahim, D.D.S., M.S. D.
- Endodontics
- Saint Clair Shores, MI
National Provider Identifier
1275974883
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 2901020971
- Practice address
- 24911 Little Mack Ave Ste B
Saint Clair Shores, MI 48080-3200 - Phone
- (586) 863-1336
- NPI assigned
- Jul 11, 2013
- Last updated
- Jan 19, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2901020971 | MI | |
| Endodontics | 1223E0200X | 2901020971 | MI | Primary |
Addresses
Primary practice location
24911 Little Mack Ave Ste B
Saint Clair Shores, MI 48080-3200
Mailing address
24911 Little Mack Ave Ste B
Saint Clair Shores, MI 48080-3200
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 |
|---|---|---|---|
| 2901020971 | MI | MD | Endodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carolin Ibrahim DDS MSD PLLC | Endodontics | Current | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1373500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642550400000",
"number": "1275974883",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24911 LITTLE MACK AVE STE B",
"city": "SAINT CLAIR SHORES",
"state": "MI",
"postal_code": "480803200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24911 LITTLE MACK AVE STE B",
"city": "SAINT CLAIR SHORES",
"state": "MI",
"postal_code": "480803200",
"telephone_number": "586-863-1336"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IBRAHIM",
"first_name": "CAROLIN",
"name_prefix": "Dr.",
"credential": "D.D.S., M.S. D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-07-11",
"last_updated": "2022-01-19",
"certification_date": "2022-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901020971",
"primary": false
},
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "MI",
"license": "2901020971",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Clair Shores, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.