Provider Demographics
NPI:1548392681
Name:AWADZI, GERALD (DMD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
Last Name:AWADZI
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 1:507 N HERSHEY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-3744
Mailing Address - Country:US
Mailing Address - Phone:309-664-2288
Mailing Address - Fax:309-664-5068
Practice Address - Street 1:507 N HERSHEY RD
Practice Address - Street 2:SUITE B
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-3744
Practice Address - Country:US
Practice Address - Phone:309-664-2288
Practice Address - Fax:309-664-5068
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist