Provider Demographics
NPI:1477642957
Name:WAHBA DENTAL CORP
Entity Type:Organization
Organization Name:WAHBA DENTAL CORP
Other - Org Name:SHERMAN WAY DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNES PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAGED
Authorized Official - Middle Name:FARES
Authorized Official - Last Name:WAHBA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-988-1642
Mailing Address - Street 1:7120 HAYVENHURST AVE
Mailing Address - Street 2:#205
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406
Mailing Address - Country:US
Mailing Address - Phone:818-988-1642
Mailing Address - Fax:818-988-0771
Practice Address - Street 1:7120 HAYVENHURST AVE
Practice Address - Street 2:#205
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406
Practice Address - Country:US
Practice Address - Phone:818-988-1642
Practice Address - Fax:818-988-0771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty