Provider Demographics
NPI:1649030669
Name:LABIB AWAD, STEPHANIE (DMD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:LABIB AWAD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4842 YACHT CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-4080
Mailing Address - Country:US
Mailing Address - Phone:774-627-5974
Mailing Address - Fax:
Practice Address - Street 1:4842 YACHT CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-4080
Practice Address - Country:US
Practice Address - Phone:774-627-5974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN27551122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist