MEDICARE: DR. ABDUL WAHEED DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3807	ME
2	1223G0001X	General Practice Dentistry	3491	NH
3	1223G0001X	General Practice Dentistry	DN18440	FL
4	122300000X	Dentist	DN18440	FL

General Provider Information

NPI Number	:	1538206123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ABDUL WAHEED DMD

Provider Business Mailing Address
First Line	:	528 W BALDWIN RD
Second Line	:	528 BALDWIN RD
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-3313
Country	:	US
Telephone Number	:	850-215-0128
Fax Number	:	850-481-1976

Provider Business Practice Location Address
First Line	:	528 W BALDWIN RD
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-3313
Country	:	US
Telephone Number	:	850-215-0128
Fax Number	:	850-481-1976

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	09/17/2024

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