Provider Demographics
NPI:1245442334
Name:RAZAK, WALAA A (DDS)
Entity type:Individual
Prefix:DR
First Name:WALAA
Middle Name:A
Last Name:RAZAK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 HORNBLEND ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-4057
Mailing Address - Country:US
Mailing Address - Phone:619-925-1453
Mailing Address - Fax:858-657-0210
Practice Address - Street 1:945 HORNBLEND ST
Practice Address - Street 2:SUITE B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-4057
Practice Address - Country:US
Practice Address - Phone:619-925-1453
Practice Address - Fax:858-657-0210
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52919122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist