Provider Demographics
NPI:1043372329
Name:WAHEED, IRUM (DDS)
Entity type:Individual
Prefix:DR
First Name:IRUM
Middle Name:
Last Name:WAHEED
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25780 GATZ ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48045-3004
Mailing Address - Country:US
Mailing Address - Phone:586-214-8582
Mailing Address - Fax:
Practice Address - Street 1:69089 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MI
Practice Address - Zip Code:48062-1146
Practice Address - Country:US
Practice Address - Phone:586-727-5898
Practice Address - Fax:586-727-8429
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019390122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist