Marwah Balasim Al Jebahje, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901602446 Issued in MI

Practice address

375 Mount Vernon St Apt 714
Dorchester, MA 02125-3162

Phone

(623) 200-6867

NPI assigned

Mar 9, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

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

State licenses

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

{
    "created_epoch": "1678320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735516800000",
    "number": "1881394591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 MOUNT VERNON ST APT 714",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "021253162",
            "telephone_number": "623-200-6867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 MOUNT VERNON ST APT 714",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "021253162",
            "telephone_number": "623-200-6867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AL JEBAHJE",
        "first_name": "MARWAH",
        "middle_name": "BALASIM",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-09",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "DN1859977",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901602446",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fawzia Ahmed
• Sam Ahn, DMD
• Omodamola Abisola Aje
• Oluwatayo Ronald Akinmuyisan
• Ayodele Christine Akinwumi
• Abdulaziz Yassir Al-Ammar
• Zakiya Alake
• Dana Alexandria Alas
• Maxwelle Albin
• Miryam Alce, RN

• General Practice Dentistry in Dorchester, MA
• Providers in Dorchester, MA by specialty
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2024; 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.