Provider Demographics
NPI:1063867018
Name:AWADALLA, LAURA (DDS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:AWADALLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6213 SPIRIT ST APT 481
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3194
Mailing Address - Country:US
Mailing Address - Phone:330-727-4430
Mailing Address - Fax:
Practice Address - Street 1:4075 MONROEVILLE BLVD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2525
Practice Address - Country:US
Practice Address - Phone:412-856-4877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
PADS0411951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program