Manal Ibrahim, DDS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Practice address

1526 Il Route 59
Joliet, IL 60431

Phone

(815) 436-8787

Fax

(815) 436-8788

NPI assigned

Nov 29, 2006

Last updated

Oct 27, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Manal Lavacca Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Dental Professionals of Illinois, P.C

  dba Innovative Dental Care of Shorewood

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Joliet, IL
  • NPI 1851971642
  NPD (past)

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193443200000",
    "number": "1730256025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1526 IL ROUTE 59",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "60431",
            "telephone_number": "815-436-8787",
            "fax_number": "815-436-8788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1526 IL ROUTE 59",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "60431",
            "telephone_number": "815-436-8787",
            "fax_number": "815-436-8788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "MANAL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-29",
        "last_updated": "2007-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "0510771",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MANAL",
            "last_name": "LAVACCA",
            "credential": "DDS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Ciro Louis Iandoli, MD
• Iatreia Mental Health SC
• Iatreia Mental Health SC
• Iatreia Mental Health SC
• Iatreia PLLC (Iatreia Clinics)
• Icrf, Inc. Medical Plaza
• Ramzi Ihmud, DMD
• Andrea Ikeda, M.S., C.P., L.P.
• Illiana Sleep Center
• Illiana Sleep Center Inc

• Orthodontics and Dentofacial Orthopedics Dentistry in Joliet, IL
• Providers in Joliet, IL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2007; 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.