Active NPI
Mohammed Ali Abdul Waris, DDS
- Dentist
- Philadelphia, PA
National Provider Identifier
1720603665
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 0401417549
- Practice address
- 5501 Old York Rd
Philadelphia, PA 19141-3018 - Phone
- (215) 456-6620
- NPI assigned
- Jun 16, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | 0401417549 | VA | Primary |
Addresses
Primary practice location
5501 Old York Rd
Philadelphia, PA 19141-3018
Mailing address
5501 Old York Road
Philadelphia, PA 19141
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401417549 | VA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1592265600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1625011200000",
"number": "1720603665",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5501 OLD YORK ROAD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "19141"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5501 OLD YORK RD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191413018",
"telephone_number": "215-456-6620"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WARIS",
"first_name": "MOHAMMED ALI",
"middle_name": "ABDUL",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-06-16",
"last_updated": "2021-06-30",
"certification_date": "2021-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VA",
"license": "0401417549",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.