Enitan C. Ibrahim, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

50613 Issued in CA

Practice address

27947 Sloan Canyon Rd
Castaic, CA 91384-2594

Phone

(661) 294-3700

Fax

(661) 294-9080

NPI assigned

Nov 14, 2006

Sex

Female

Sole proprietor

No

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

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1241049600000",
    "number": "1669544862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27947 SLOAN CANYON RD",
            "city": "CASTAIC",
            "state": "CA",
            "postal_code": "913842594",
            "telephone_number": "661-294-3700",
            "fax_number": "661-294-9080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27947 SLOAN CANYON RD",
            "city": "CASTAIC",
            "state": "CA",
            "postal_code": "913842594",
            "telephone_number": "661-294-3700",
            "fax_number": "661-294-9080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "ENITAN",
        "middle_name": "C.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-14",
        "last_updated": "2009-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "50613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Glenoaks Chiropractic
• Carlos Omar Godinez Guzman
• Lindsay Heber, PSYD
• Cindy Herrera, NP, RN
• Queenie Hill, RD
• Breanne Jagiello, M.S., BCBA
• James a. Uhrik, D.D.S., Inc. (Castaic Dental Center)
• Alan Wilson Jarjour, DMD
• Kristen Janelle Jensen, M.S., BCBA
• JMT First Assists

• General Practice Dentistry in Castaic, CA
• Providers in Castaic, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.