Maryou Ibrahim

Key facts

NPI

1336039387

Entity type

Individual (NPI type 1)

Primary specialty

General Practice Dentistry 1223G0001X

License

30.028081 (OH)

Practice address

22245 Lorain Rd
Fairview Park, OH 44126-3315

Phone

(440) 644-8100

NPI assigned

Jul 9, 2025

Sex

Male

Sole proprietor

No

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.

• Bradley Warren Hylan DMD Fairview LLC Dental Clinic/Center · Fairview Park, OH · NPI 1861112138
  NPD

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 9, 2025.

{
    "created_epoch": "1752019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752019200000",
    "number": "1336039387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22245 LORAIN RD",
            "city": "FAIRVIEW PARK",
            "state": "OH",
            "postal_code": "441263315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22245 LORAIN RD",
            "city": "FAIRVIEW PARK",
            "state": "OH",
            "postal_code": "441263315",
            "telephone_number": "440-644-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "MARYOU",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-07-09",
        "last_updated": "2025-07-09",
        "certification_date": "2025-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30.028081",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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