Provider Demographics
NPI:1598653388
Name:MORRAR, WISAM RIAD (DDS)
Entity type:Individual
Prefix:
First Name:WISAM
Middle Name:RIAD
Last Name:MORRAR
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 1:5413 E BROOK WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-4758
Mailing Address - Country:US
Mailing Address - Phone:916-470-4221
Mailing Address - Fax:
Practice Address - Street 1:8211 BRUCEVILLE RD STE 155
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2313
Practice Address - Country:US
Practice Address - Phone:916-525-7635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111825122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist