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General NPI Number Information
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NPI Number | 1083419568
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Entity Type | Individual
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Provider Name | WIAM ISMAIL DDS
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Gender | Male
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Dates
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Enumeration Date | 02/18/2025
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 12090 E ALAMEDA AVE
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City | AURORA
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State | CO
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Zip | 80012-1216
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Country | US
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Telephone | 303-360-8365
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 N URSULA ST APT 230
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City | AURORA
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State | CO
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Zip | 80045-7604
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Country | US
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Telephone | 832-712-6017
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 00206064
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License Number State | CO
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