MEDICARE: ABSOLUTE DENTAL CARE / MW DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1174450514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABSOLUTE DENTAL CARE / MW DENTAL

Provider Business Mailing Address
First Line	:	7512 IRON BAR LN
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-2999
Country	:	US
Telephone Number	:	571-248-1114
Fax Number	:

Provider Business Practice Location Address
First Line	:	7512 IRON BAR LN
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-2999
Country	:	US
Telephone Number	:	571-248-1114
Fax Number	:

Authorized Official
Title or Position	:	GENERAL DENTIST
Name	:	THAMER WISAM
Credential	:	DMD
Telephone Number	:	571-248-1114

Provider Enumeration Date	:	05/07/2026
Last Update Date	:	05/07/2026

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