Provider Demographics
NPI:1164065421
Name:SNOON DENTAL PRACTICE OF DR. WISAM AL-RAWI INC.
Entity Type:Organization
Organization Name:SNOON DENTAL PRACTICE OF DR. WISAM AL-RAWI INC.
Other - Org Name:SNOON DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WISAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-RAWI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:424-666-8116
Mailing Address - Street 1:407 W MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-3226
Mailing Address - Country:US
Mailing Address - Phone:619-401-0444
Mailing Address - Fax:
Practice Address - Street 1:407 W MADISON AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3226
Practice Address - Country:US
Practice Address - Phone:619-401-0444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-19
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental