Provider Demographics
NPI:1417252289
Name:WAREHAM FAMILY DENTAL, INC.
Entity Type:Organization
Organization Name:WAREHAM FAMILY DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YASER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WEHBE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-295-7476
Mailing Address - Street 1:108 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-2052
Mailing Address - Country:US
Mailing Address - Phone:508-295-7476
Mailing Address - Fax:
Practice Address - Street 1:108 HIGH ST
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-2052
Practice Address - Country:US
Practice Address - Phone:508-295-7476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty