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General NPI Number Information
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NPI Number | 1871181826
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Entity Type | Organization
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Legal Business Name | WAISE EBRAHIMI DDS PC
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Dates
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Enumeration Date | 01/05/2021
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 841 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10003-4704
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Country | US
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Telephone | 332-237-6453
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Fax |
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Provider Business Mailing Address
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Address Line | 841 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10003-4704
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Country | US
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Telephone | 925-548-7869
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WAISE EBRAHIMI
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Credential | DDS
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Telephone | 925-548-7869
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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 |
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License Number State |
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