Healthcare Provider Details

I. General information

NPI: 1174450514
Provider Name (Legal Business Name): ABSOLUTE DENTAL CARE / MW DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7512 IRON BAR LN
GAINESVILLE VA
20155-2999
US

IV. Provider business mailing address

7512 IRON BAR LN
GAINESVILLE VA
20155-2999
US

V. Phone/Fax

Practice location:
  • Phone: 571-248-1114
  • Fax:
Mailing address:
  • Phone: 571-248-1114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: THAMER WISAM
Title or Position: GENERAL DENTIST
Credential: DMD
Phone: 571-248-1114