Provider Demographics
NPI:1598939811
Name:MAMMO, WALEED A (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALEED
Middle Name:A
Last Name:MAMMO
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 1:35450 DEQUINDRE RD
Mailing Address - Street 2:SUTE 101
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4810
Mailing Address - Country:US
Mailing Address - Phone:586-264-6550
Mailing Address - Fax:586-795-3282
Practice Address - Street 1:35450 DEQUINDRE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4810
Practice Address - Country:US
Practice Address - Phone:586-264-6550
Practice Address - Fax:586-795-3282
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901015678122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist