Provider Demographics
NPI:1871888123
Name:AL-RAWI, WISAM (DDS)
Entity type:Individual
Prefix:DR
First Name:WISAM
Middle Name:
Last Name:AL-RAWI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 8TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-6827
Mailing Address - Country:US
Mailing Address - Phone:424-666-8116
Mailing Address - Fax:
Practice Address - Street 1:2728 WESTMOOR CT SW STE A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5779
Practice Address - Country:US
Practice Address - Phone:360-709-9909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61240511122300000X
MI29010203621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice