Provider Demographics
NPI:1659019842
Name:WASEY, ABDUL (DMD)
Entity type:Individual
Prefix:
First Name:ABDUL
Middle Name:
Last Name:WASEY
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 1:379 E GLEN EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3641
Mailing Address - Country:US
Mailing Address - Phone:440-840-9406
Mailing Address - Fax:
Practice Address - Street 1:9500 MENTOR AVE STE 110
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-8712
Practice Address - Country:US
Practice Address - Phone:440-352-2887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0268541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty