Provider Demographics
NPI:1760576250
Name:ABDULWAHEED, ABDULLAIBRAHIM (DMD, MAGD)
Entity Type:Individual
Prefix:DR
First Name:ABDULLAIBRAHIM
Middle Name:
Last Name:ABDULWAHEED
Suffix:
Gender:M
Credentials:DMD, MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5834
Mailing Address - Country:US
Mailing Address - Phone:617-639-5942
Mailing Address - Fax:
Practice Address - Street 1:505 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5834
Practice Address - Country:US
Practice Address - Phone:617-639-5942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20827122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist