Provider Demographics
NPI:1083771265
Name:KANAWATI, RAGAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAGAD
Middle Name:
Last Name:KANAWATI
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 1:5400 E WILLIAMS BLVD
Mailing Address - Street 2:APT. #2301
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-4411
Mailing Address - Country:US
Mailing Address - Phone:304-320-7997
Mailing Address - Fax:
Practice Address - Street 1:7701 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-3941
Practice Address - Country:US
Practice Address - Phone:520-546-3584
Practice Address - Fax:520-546-3644
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD71601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice