Provider Demographics
NPI:1780869305
Name:AWAYES, GAMILA MIMI (DMD)
Entity type:Individual
Prefix:
First Name:GAMILA
Middle Name:MIMI
Last Name:AWAYES
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 1:4600B PINECREST OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-1460
Mailing Address - Country:US
Mailing Address - Phone:703-914-0020
Mailing Address - Fax:
Practice Address - Street 1:4600B PINECREST OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-1460
Practice Address - Country:US
Practice Address - Phone:703-914-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010078371223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0401007837OtherVA DENTAL LICENSE