Provider Demographics
NPI:1790592566
Name:WASEF, WESSAM (DMD)
Entity type:Individual
Prefix:DR
First Name:WESSAM
Middle Name:
Last Name:WASEF
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 1:102 MCCALL CT
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-4536
Mailing Address - Country:US
Mailing Address - Phone:207-415-7685
Mailing Address - Fax:
Practice Address - Street 1:153 WORTH GUARD RD
Practice Address - Street 2:
Practice Address - City:COINJOCK
Practice Address - State:NC
Practice Address - Zip Code:27923-9766
Practice Address - Country:US
Practice Address - Phone:252-453-2181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14024122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist