Healthcare Provider Details

I. General information

NPI: 1568001303
Provider Name (Legal Business Name): JOSEPH ANTOINE WAKIM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2019
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4441 HOFFNER AVE
ORLANDO FL
32812-2331
US

IV. Provider business mailing address

710 N WOODCHUCK ST
WICHITA KS
67212-3628
US

V. Phone/Fax

Practice location:
  • Phone: 407-218-4744
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number61533
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN30761
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: