Provider Demographics
NPI:1811774102
Name:MEAWAD, KARL (DDS)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:
Last Name:MEAWAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 S CATALINA ST APT PHQ
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-1740
Mailing Address - Country:US
Mailing Address - Phone:347-443-6149
Mailing Address - Fax:
Practice Address - Street 1:962 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-1405
Practice Address - Country:US
Practice Address - Phone:310-539-3245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1093461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice