Provider Demographics
NPI:1083419568
Name:ISMAIL, WIAM (DDS)
Entity type:Individual
Prefix:
First Name:WIAM
Middle Name:
Last Name:ISMAIL
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 N URSULA ST APT 230
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7604
Mailing Address - Country:US
Mailing Address - Phone:832-712-6017
Mailing Address - Fax:
Practice Address - Street 1:12090 E ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-1216
Practice Address - Country:US
Practice Address - Phone:303-360-8365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00206064122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist