Wissam Azzam, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

13054 Issued in NC

Practice address

1000 Crescent GRN Ste 200
Cary, NC 27518-8117

Phone

(919) 851-0011

NPI assigned

Jan 28, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Riccobene & Associates Xiii, DDS, P.a.

  dba Riccobene Dentistry for Kids - Cary

  • Pediatric Dentistry
  • Cary, NC
  • NPI 1265778963
  NPD

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

{
    "created_epoch": "1643328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1497408512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 CRESCENT GRN STE 200",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275188117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 CRESCENT GRN STE 200",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275188117",
            "telephone_number": "919-851-0011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Stony Brook University School Of Dental Medicine Rm 11",
            "address_purpose": "LOCATION",
            "city": "Stony Brook",
            "state": "NY",
            "postal_code": "117940001",
            "country_code": "US",
            "telephone_number": "631-632-8989",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AZZAM",
        "first_name": "WISSAM",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-01-28",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NC",
            "license": "13054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Don Fernando Azevedo, PH.D.
• Kimberly M Azevedo, LMFTA
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• Marwa Baali
• Ugochi Babajide, MA, NCC, LPC
• Jameel John Babak
• Zarrina Babakulova, DMD

• Pediatric Dentistry in Cary, NC
• Providers in Cary, NC by specialty
• Pediatric Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.