MEDICARE: WME, LLC

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	0401410301	VA

General Provider Information

NPI Number	:	1952752404
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WME, LLC

Provider Business Mailing Address
First Line	:	14389 HEREFORD RD
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-2107
Country	:	US
Telephone Number	:	703-878-8000
Fax Number	:	703-878-8008

Provider Business Practice Location Address
First Line	:	14389 HEREFORD RD
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-2107
Country	:	US
Telephone Number	:	703-878-8000
Fax Number	:	703-878-8008

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MIRWEISS NAWAZ
Credential	:
Telephone Number	:	703-878-8000

Provider Enumeration Date	:	06/27/2016
Last Update Date	:	06/27/2016

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