Provider Demographics
NPI:1689098006
Name:WASSIF FAMILY AND COSMETIC DENTISTRY, DDS, PA
Entity Type:Organization
Organization Name:WASSIF FAMILY AND COSMETIC DENTISTRY, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:B
Authorized Official - Last Name:WASSIF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-687-1162
Mailing Address - Street 1:903 FUSELAGE AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-4512
Mailing Address - Country:US
Mailing Address - Phone:410-687-1162
Mailing Address - Fax:410-687-2140
Practice Address - Street 1:903 FUSELAGE AVE
Practice Address - Street 2:
Practice Address - City:MIDDLE RIVER
Practice Address - State:MD
Practice Address - Zip Code:21220-4512
Practice Address - Country:US
Practice Address - Phone:410-687-1162
Practice Address - Fax:410-687-2140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD125951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty