Provider Demographics
NPI:1932676699
Name:MARYAM WAHEED DENTAL GROUP CORP
Entity Type:Organization
Organization Name:MARYAM WAHEED DENTAL GROUP CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHEED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-840-0409
Mailing Address - Street 1:22373 EL TORO RD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-5053
Mailing Address - Country:US
Mailing Address - Phone:516-840-0409
Mailing Address - Fax:
Practice Address - Street 1:22373 EL TORO RD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-5053
Practice Address - Country:US
Practice Address - Phone:516-840-0409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-30
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty