NPIMap

Organization Active NPI

Maisy Ibrahim Dental Corporation

Doing business as Desert Dental Spa

  • Dentist
  • Palm Desert, CA
National Provider Identifier
1427319763
Registry record updated Jun 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
43447 Issued in CA
Legal business name
MAISY IBRAHIM DENTAL CORPORATION
Doing business as
Desert Dental Spa
Practice address
41990 Cook St
Suite D402
Palm Desert, CA 92211-6100
Phone
(760) 340-0303
Fax
(760) 346-2304
NPI assigned
Jun 4, 2012
Last updated
Jun 22, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2015

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

Authorized official

Name
Dr. Maisy S Ibrahim, DDS, DMD,DSMNPI 1619010840
Title
Owner
Phone
(760) 340-0303

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 43447 CA Primary
Customized Equipment (DME) 332BC3200X

Addresses

Primary practice location

41990 Cook St
Suite D402
Palm Desert, CA 92211-6100

Mailing address

41990 Cook St
Suite D402
Palm Desert, CA 92211-6100
Phone (760) 340-0303

Other names 1

  • Desert Dental Spa Doing business as

National Provider Directory

National Provider Directory

Locations

41990 Cook St
Ste D402
Palm Desert, CA 92211
Phone (760) 340-0303

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1338768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434931200000",
    "number": "1427319763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41990 COOK ST",
            "address_2": "SUITE D402",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922116100",
            "telephone_number": "760-340-0303",
            "fax_number": "760-346-2304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41990 COOK ST",
            "address_2": "SUITE D402",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922116100",
            "telephone_number": "760-340-0303",
            "fax_number": "760-346-2304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAISY IBRAHIM DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-04",
        "last_updated": "2015-06-22",
        "status": "A",
        "authorized_official_last_name": "IBRAHIM",
        "authorized_official_first_name": "MAISY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "760-340-0303",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, DMD,DSM"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "43447",
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Desert Dental Spa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Palm Desert, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2015; 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.