Provider Demographics
NPI:1851980494
Name:ANTONIOUS DAWOOD DMD CORP
Entity Type:Organization
Organization Name:ANTONIOUS DAWOOD DMD CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIOUS
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-709-5688
Mailing Address - Street 1:6462 WESTMINSTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-3601
Mailing Address - Country:US
Mailing Address - Phone:714-898-8728
Mailing Address - Fax:714-898-8729
Practice Address - Street 1:6462 WESTMINSTER BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-3601
Practice Address - Country:US
Practice Address - Phone:714-898-8728
Practice Address - Fax:714-898-8729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-17
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty