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General NPI Number Information
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NPI Number | 1093277808
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Entity Type | Individual
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Provider Name | REBAZ WAISE
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Gender | Male
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Dates
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Enumeration Date | 04/01/2019
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 1286 E WEST HWY
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City | SILVER SPRING
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State | MD
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Zip | 20910-3242
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Country | US
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Telephone | 301-761-4489
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Fax |
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Provider Business Mailing Address
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Address Line | 7934 WENTWORTH PL
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City | SPRINGFIELD
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State | VA
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Zip | 22152-3440
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Country | US
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Telephone | 703-965-1514
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 0438000487
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 18178
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401416705
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License Number State | VA
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