Healthcare Provider Details

I. General information

NPI: 1750010310
Provider Name (Legal Business Name): WAHEED M DENTAL OF WEST COVINA CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1647 W GARVEY AVE N
WEST COVINA CA
91790-2141
US

IV. Provider business mailing address

1647 W GARVEY AVE N
WEST COVINA CA
91790-2141
US

V. Phone/Fax

Practice location:
  • Phone: 516-840-0409
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MARYAM WAHEED
Title or Position: DENTIST
Credential:
Phone: 516-840-0409