Provider Demographics
NPI:1841342904
Name:WAKED, EMILE JOSEPH II (DDS)
Entity type:Individual
Prefix:DR
First Name:EMILE
Middle Name:JOSEPH
Last Name:WAKED
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 E CLARK AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-5189
Mailing Address - Country:US
Mailing Address - Phone:805-937-2059
Mailing Address - Fax:805-937-0762
Practice Address - Street 1:1108 E CLARK AVE STE 160
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-5189
Practice Address - Country:US
Practice Address - Phone:805-937-2059
Practice Address - Fax:805-937-0762
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABW501131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice