Provider Demographics
NPI:1326787201
Name:ABDUL-WASAY, SYED SALIM (DDS)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:SALIM
Last Name:ABDUL-WASAY
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 1:150 COYOTE CRESENT
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:K2S2G5
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:811 W. WELLINGTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657
Practice Address - Country:US
Practice Address - Phone:773-871-6138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2023-05-11
Deactivation Date:2023-02-27
Deactivation Code:
Reactivation Date:2023-05-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program