Provider Demographics
NPI:1770856700
Name:NADI, TAWFIQ S (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAWFIQ
Middle Name:S
Last Name:NADI
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 1:4915 WASHINGTON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4221
Mailing Address - Country:US
Mailing Address - Phone:414-326-8778
Mailing Address - Fax:
Practice Address - Street 1:4915 WASHINGTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-4221
Practice Address - Country:US
Practice Address - Phone:414-326-8778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6839-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist