Provider Demographics
NPI:1821626706
Name:AWAD, BISHOY
Entity Type:Individual
Prefix:
First Name:BISHOY
Middle Name:
Last Name:AWAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2536 ROUNDHILL CIR
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-8737
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2536 ROUNDHILL CIR
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-8737
Practice Address - Country:US
Practice Address - Phone:530-651-3199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2022-06-14
Deactivation Date:2021-08-24
Deactivation Code:
Reactivation Date:2021-12-17
Provider Licenses
StateLicense IDTaxonomies
CA106702122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist