Provider Demographics
NPI:1285787416
Name:WAHBA, DANIEL
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:WAHBA
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 1:1908 LAND O LAKES BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-2914
Mailing Address - Country:US
Mailing Address - Phone:813-909-1555
Mailing Address - Fax:813-909-1556
Practice Address - Street 1:1908 LAND O LAKES BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-2914
Practice Address - Country:US
Practice Address - Phone:813-909-1555
Practice Address - Fax:813-909-1556
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN153391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice