Healthcare Provider Details

I. General information

NPI: 1992627665
Provider Name (Legal Business Name): ABDUL WASEY DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2276 S HIGLEY RD SUITE 105
GILBERT AZ
85295
US

IV. Provider business mailing address

12400 N TATUM BLVD UNIT 5072
PHOENIX AZ
85032-0045
US

V. Phone/Fax

Practice location:
  • Phone: 440-840-9406
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ABDUL WASEY
Title or Position: DENTIST
Credential: DMD
Phone: 440-840-9406