Provider Demographics
NPI:1285016022
Name:WEHBE, HAITHAM
Entity Type:Individual
Prefix:
First Name:HAITHAM
Middle Name:
Last Name:WEHBE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5998 STATE RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-2867
Mailing Address - Country:US
Mailing Address - Phone:440-884-0640
Mailing Address - Fax:440-884-4393
Practice Address - Street 1:5998 STATE RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134
Practice Address - Country:US
Practice Address - Phone:440-884-0640
Practice Address - Fax:440-884-4393
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-28
Last Update Date:2018-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300245161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice