Provider Demographics
NPI:1275716961
Name:WAHIB, SHOKRI A (DDS)
Entity Type:Individual
Prefix:
First Name:SHOKRI
Middle Name:A
Last Name:WAHIB
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 1:29099 HEALTH CAMPUS DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5200
Mailing Address - Country:US
Mailing Address - Phone:440-892-7773
Mailing Address - Fax:
Practice Address - Street 1:29099 HEALTH CAMPUS DR
Practice Address - Street 2:SUITE 220
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5200
Practice Address - Country:US
Practice Address - Phone:440-892-7773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH197721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0935902Medicaid
OH4040351Medicare PIN
OH0935902Medicaid