Provider Demographics
NPI:1194488262
Name:ABDELSAYED AND WASSIF DENTAL GROUP IN
Entity Type:Organization
Organization Name:ABDELSAYED AND WASSIF DENTAL GROUP IN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELSAYED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:424-379-7261
Mailing Address - Street 1:16141 BOLSA CHICA ST STE C
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-2458
Mailing Address - Country:US
Mailing Address - Phone:714-846-1386
Mailing Address - Fax:
Practice Address - Street 1:16141 BOLSA CHICA ST STE C
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-2458
Practice Address - Country:US
Practice Address - Phone:714-846-1386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-15
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1366081747Medicaid
IL1871117507Medicaid