Provider Demographics
NPI:1891157053
Name:NAHLA WADIE DDS
Entity type:Organization
Organization Name:NAHLA WADIE DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAHLA
Authorized Official - Middle Name:
Authorized Official - Last Name:WADIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-539-7781
Mailing Address - Street 1:31487 NORTHWESTERN HWY
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-5415
Mailing Address - Country:US
Mailing Address - Phone:248-539-7781
Mailing Address - Fax:248-539-7782
Practice Address - Street 1:31487 NORTHWESTEREN HWY
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334
Practice Address - Country:US
Practice Address - Phone:248-539-7781
Practice Address - Fax:248-539-7782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI16611122300000X
MI2901016611122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1114024726Medicaid