Provider Demographics
NPI:1417125345
Name:AWAN, ASIM (DDS)
Entity Type:Individual
Prefix:
First Name:ASIM
Middle Name:
Last Name:AWAN
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 1:4670 GREEN BRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-2930
Mailing Address - Country:US
Mailing Address - Phone:312-480-8720
Mailing Address - Fax:
Practice Address - Street 1:2812 HASSERT BLVD STE 104
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5826
Practice Address - Country:US
Practice Address - Phone:312-480-8720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011103A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist