Provider Demographics
NPI:1821626706
Name:AWAD, BISHOY
Entity type:Individual
Prefix:
First Name:BISHOY
Middle Name:
Last Name:AWAD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 194TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4604
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4111 194TH ST SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4604
Practice Address - Country:US
Practice Address - Phone:530-651-3199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2025-04-02
Deactivation Date:2021-08-24
Deactivation Code:
Reactivation Date:2021-12-17
Provider Licenses
StateLicense IDTaxonomies
WA61602657122300000X
CA106702122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist