Provider Demographics
NPI:1639427123
Name:DENTIST ON WHEELS, INC
Entity Type:Organization
Organization Name:DENTIST ON WHEELS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AYMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:855-369-8585
Mailing Address - Street 1:3350 SW 148TH AVE
Mailing Address - Street 2:#110
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3257
Mailing Address - Country:US
Mailing Address - Phone:855-369-8585
Mailing Address - Fax:
Practice Address - Street 1:20 F ST NW
Practice Address - Street 2:7TH FLOOR
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-6700
Practice Address - Country:US
Practice Address - Phone:855-369-8585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11746122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty