Provider Demographics
NPI:1871804781
Name:HARON, IBRAHIM M (DDS)
Entity type:Individual
Prefix:DR
First Name:IBRAHIM
Middle Name:M
Last Name:HARON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10009 SOUTHPOINT PKWY
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-2709
Mailing Address - Country:US
Mailing Address - Phone:540-225-2259
Mailing Address - Fax:540-225-2253
Practice Address - Street 1:10009 SOUTHPOINT PKWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-2709
Practice Address - Country:US
Practice Address - Phone:540-225-2259
Practice Address - Fax:540-225-2253
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414186122300000X, 1223S0112X
VA04380003551223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist