Provider Demographics
NPI:1396393864
Name:EL-AWADI DDS, PLLC
Entity Type:Organization
Organization Name:EL-AWADI DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WASSIM
Authorized Official - Middle Name:AWAD
Authorized Official - Last Name:EL AWADI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-377-0264
Mailing Address - Street 1:26000 HOOVER RD STE 102
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-1167
Mailing Address - Country:US
Mailing Address - Phone:586-480-2256
Mailing Address - Fax:586-806-5212
Practice Address - Street 1:26000 HOOVER RD STE 102
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-1167
Practice Address - Country:US
Practice Address - Phone:586-480-2256
Practice Address - Fax:586-806-5212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental