Healthcare Provider Details

I. General information

NPI: 1063556207
Provider Name (Legal Business Name): WADIH NAIM DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 AVE FD ROOSEVELT LA TORRE DE PLAZA STE 706
SAN JUAN PR
00918-8001
US

IV. Provider business mailing address

45 CALLE CALISTEMON ESTANCIAS DE TORRIMAR
GUAYNABO PR
00966-3166
US

V. Phone/Fax

Practice location:
  • Phone: 787-753-3605
  • Fax: 787-753-3605
Mailing address:
  • Phone: 787-783-1674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number1834
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: