Provider Demographics
NPI:1013277037
Name:DAWOUD, MARK M (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:M
Last Name:DAWOUD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:20 OMNI PARC DR
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-5904
Mailing Address - Country:US
Mailing Address - Phone:845-325-8635
Mailing Address - Fax:
Practice Address - Street 1:75 DOLSON AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-6501
Practice Address - Country:US
Practice Address - Phone:845-325-8635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18559431223P0221X
NY058404-11223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry