Provider Demographics
NPI:1114024726
Name:WADIE, NAHLA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:NAHLA
Middle Name:
Last Name:WADIE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32910 W 13 MILE RD
Mailing Address - Street 2:STE A-100
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334
Mailing Address - Country:US
Mailing Address - Phone:248-539-7781
Mailing Address - Fax:248-539-7782
Practice Address - Street 1:32910 W 13 MILE RD
Practice Address - Street 2:STE A-100
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334
Practice Address - Country:US
Practice Address - Phone:248-539-7781
Practice Address - Fax:248-539-7782
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016611122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist