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General NPI Number Information
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NPI Number | 1871014001
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Entity Type | Individual
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Provider Name | WAKAS S. ABDULRAZZAQ D.M.D
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Gender | Male
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Dates
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Enumeration Date | 06/28/2017
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 3751 BRUCE B DOWNS BLVD
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-9201
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Country | US
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Telephone | 813-575-1008
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Fax |
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Provider Business Mailing Address
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Address Line | 2420 14TH ST NW APT 531
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City | WASHINGTON
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State | DC
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Zip | 20009-3754
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Country | US
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Telephone | 443-224-0737
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019031122
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 0401416743
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 17615
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN28972
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License Number State | FL
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