Provider Demographics
NPI:1093054991
Name:AL-DARKAZALI, AWS (DMD)
Entity Type:Individual
Prefix:
First Name:AWS
Middle Name:
Last Name:AL-DARKAZALI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 STONE LAKES DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-7137
Mailing Address - Country:US
Mailing Address - Phone:817-864-1164
Mailing Address - Fax:817-864-1164
Practice Address - Street 1:9160 N TARRANT PKWY
Practice Address - Street 2:SUITE 130
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182
Practice Address - Country:US
Practice Address - Phone:817-864-1164
Practice Address - Fax:817-864-1164
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29939122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI20150729008057Medicare PIN