=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013432707
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | UMAIR WAHEED DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2017
-----------------------------------------------------
Last Update Date | 09/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22537 HALL RD
-----------------------------------------------------
City | MACOMB
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48042-5219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-784-6725
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 38934 N POINTE PKWY
-----------------------------------------------------
City | HARRISON TWP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48045-6813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-409-1773
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 2901022348
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------