Provider Demographics
NPI:1902930373
Name:IBRAHIM, HASHEM AND SALEM DENTAL CORPORATION
Entity Type:Organization
Organization Name:IBRAHIM, HASHEM AND SALEM DENTAL CORPORATION
Other - Org Name:KIRBY AND FLORIDA DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:AYMAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HASHEM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-766-5177
Mailing Address - Street 1:2585 W FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-4615
Mailing Address - Country:US
Mailing Address - Phone:951-766-5177
Mailing Address - Fax:951-766-9655
Practice Address - Street 1:2585 W FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-4615
Practice Address - Country:US
Practice Address - Phone:951-766-5177
Practice Address - Fax:951-766-9655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA286391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty