Individual
REBAZ WAISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
0401416705
VA
122300000X
Dentist
18178
MD
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
0438000487
VA
Other
Enumeration date
04/01/2019
Last updated
01/08/2026
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