Provider Demographics
NPI:1639289754
Name:AWAYES, ADLY TAREK (DMD)
Entity Type:Individual
Prefix:MR
First Name:ADLY
Middle Name:TAREK
Last Name:AWAYES
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 1:513 SOUTH DUPONT HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963
Mailing Address - Country:US
Mailing Address - Phone:302-422-7800
Mailing Address - Fax:302-422-8123
Practice Address - Street 1:513 SOUTH DUPONT HIGHWAY
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963
Practice Address - Country:US
Practice Address - Phone:302-422-7800
Practice Address - Fax:302-422-8123
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG10001091122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000954008Medicaid