Provider Demographics
NPI:1073343240
Name:VICTOR, WAEL SAMEER
Entity type:Individual
Prefix:
First Name:WAEL
Middle Name:SAMEER
Last Name:VICTOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49107 CRANBERRY CT
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-3407
Mailing Address - Country:US
Mailing Address - Phone:586-668-3550
Mailing Address - Fax:
Practice Address - Street 1:763 RIO RANCHO RD STE 120
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-7015
Practice Address - Country:US
Practice Address - Phone:909-242-7989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-03
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1104191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice