Individual provider Active NPI

Kyrolos Ibrahim

  • General Practice Dentistry
  • Wellesley, MA
National Provider Identifier
1689415036
Registry record updated Jan 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN10000258 Issued in MA
Practice address
20 William St Ste G75
Wellesley, MA 02481-4142
Phone
(781) 235-9018
NPI assigned
May 31, 2024
Last updated
Jan 11, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN10000258 MA Primary

Addresses

Primary practice location

20 William St Ste G75
Wellesley, MA 02481-4142

Mailing address

20 William St Ste G75
Wellesley, MA 02481-4142

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

LicenseStateTypeSpecialty
DN10000258MAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Milford Smiles General Practice PastSince Jun 2, 2024 Accepting new patients
Milford Smiles General Practice PastSince Jun 2, 2024 Accepting new patients

Organizations & group practices 2

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": "1717113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768089600000",
    "number": "1689415036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 WILLIAM ST STE G75",
            "city": "WELLESLEY",
            "state": "MA",
            "postal_code": "024814142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 WILLIAM ST STE G75",
            "city": "WELLESLEY",
            "state": "MA",
            "postal_code": "024814142",
            "telephone_number": "781-235-9018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "KYROLOS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-05-31",
        "last_updated": "2026-01-11",
        "certification_date": "2026-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "DN10000258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wellesley, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2026; 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.