Provider Demographics
NPI:1326041328
Name:TAWADROS, ATEF MILAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ATEF
Middle Name:MILAD
Last Name:TAWADROS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-2024
Mailing Address - Country:US
Mailing Address - Phone:574-255-2636
Mailing Address - Fax:
Practice Address - Street 1:116 W 3RD ST
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-2024
Practice Address - Country:US
Practice Address - Phone:574-255-2636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008042A1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery