Provider Demographics
NPI:1659677508
Name:AWAD, MEDHAT F (DDS)
Entity Type:Individual
Prefix:DR
First Name:MEDHAT
Middle Name:F
Last Name:AWAD
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 1:135 W 27TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6226
Mailing Address - Country:US
Mailing Address - Phone:212-594-7171
Mailing Address - Fax:
Practice Address - Street 1:135 W 27TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6226
Practice Address - Country:US
Practice Address - Phone:212-594-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0494311223G0001X
NJ22DI021489001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice