Provider Demographics
NPI:1992312680
Name:WAELY DENTAL PLLC
Entity type:Organization
Organization Name:WAELY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF DENTAL SURGERY
Authorized Official - Prefix:DR
Authorized Official - First Name:RUAA
Authorized Official - Middle Name:
Authorized Official - Last Name:WAELY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-626-0476
Mailing Address - Street 1:23902 ANN ARBOR TRL
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-1452
Mailing Address - Country:US
Mailing Address - Phone:313-925-5179
Mailing Address - Fax:
Practice Address - Street 1:1769 INKSTER RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-3028
Practice Address - Country:US
Practice Address - Phone:734-421-4150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAELY DENTAL PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-26
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty