Provider Demographics
NPI:1871014001
Name:ABDULRAZZAQ, WAKAS S (DMD)
Entity Type:Individual
Prefix:DR
First Name:WAKAS
Middle Name:S
Last Name:ABDULRAZZAQ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 14TH ST NW APT 531
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-3754
Mailing Address - Country:US
Mailing Address - Phone:443-224-0737
Mailing Address - Fax:
Practice Address - Street 1:2410 EVERGREEN RD STE 101
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1979
Practice Address - Country:US
Practice Address - Phone:410-721-3403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190311221223G0001X
VA04014167431223X0400X
MD176151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice