Sam Wakim, D.M.D, M.P.H

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DI 21632 Issued in NJ

Practice address

17 S Warren St
Dover, NJ 07801-4506

Phone

(973) 328-9100

NPI assigned

May 12, 2008

Last updated

Feb 27, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Zufall Health Center, Inc

  dba Highlands Health Van

  • Federally Qualified Health Center (FQHC)
  • Dover, NJ
  • NPI 1750618260

  Corporate Officer

  CMS ownership

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330300800000",
    "number": "1053588798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "331 W MAIN ST",
            "city": "DENVILLE",
            "state": "NJ",
            "postal_code": "078341214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 S WARREN ST",
            "city": "DOVER",
            "state": "NJ",
            "postal_code": "078014506",
            "telephone_number": "973-328-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAKIM",
        "first_name": "SAM",
        "name_prefix": "Dr.",
        "credential": "D.M.D, M.P.H",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-12",
        "last_updated": "2012-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "NJ",
            "license": "DI 21632",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "DI 21632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chantelle R Varrial Grant, DC
• Gemma Fay Vazquez, M.A., BCBA
• Vital Medical Forces of Dover PC
• W H Goodale Co (Goodale Surgical Supply)
• W H Goodale Co (Goodale Pharmacy)
• Walgreen Co (Walgreens #10379)
• Joseph J Wallis, DO
• Michael Thomas Ward, DC
• Warmth Counseling LLC
• Roger Elroy Warn, MS, RDN, CDE

• General Practice Dentistry in Dover, NJ
• Providers in Dover, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.