Provider Demographics
NPI:1558034116
Name:AWADALLAH, TESNEIM (DMD)
Entity Type:Individual
Prefix:MRS
First Name:TESNEIM
Middle Name:
Last Name:AWADALLAH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 W 87TH ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-2902
Mailing Address - Country:US
Mailing Address - Phone:708-952-0000
Mailing Address - Fax:708-952-0001
Practice Address - Street 1:5600 W 87TH ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-2902
Practice Address - Country:US
Practice Address - Phone:708-952-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190333511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice