Provider Demographics
NPI:1174734693
Name:AL-HASHIMI, IBTISAM (BDS, MS, PHD)
Entity type:Individual
Prefix:DR
First Name:IBTISAM
Middle Name:
Last Name:AL-HASHIMI
Suffix:
Gender:F
Credentials:BDS, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:469-291-2000
Mailing Address - Fax:
Practice Address - Street 1:6333 FOREST PARK
Practice Address - Street 2:SUITE 130
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9109
Practice Address - Country:US
Practice Address - Phone:214-645-3999
Practice Address - Fax:214-645-3989
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF-21792122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist