Healthcare Provider Details

I. General information

NPI: 1720905748
Provider Name (Legal Business Name): WASSEM WASEF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 MCLAWS CIR
WILLIAMSBURG VA
23185-5649
US

IV. Provider business mailing address

277 MCLAWS CIR
WILLIAMSBURG VA
23185-5649
US

V. Phone/Fax

Practice location:
  • Phone: 757-229-1224
  • Fax:
Mailing address:
  • Phone: 757-229-1224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401420118
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: