Provider Demographics
NPI:1932798055
Name:TAWIL, JAD WILLIAM (DMD)
Entity Type:Individual
Prefix:
First Name:JAD
Middle Name:WILLIAM
Last Name:TAWIL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 N PEAK ST APT 1121
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3669
Mailing Address - Country:US
Mailing Address - Phone:732-853-2817
Mailing Address - Fax:
Practice Address - Street 1:315 N GALLOWAY AVE
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-4362
Practice Address - Country:US
Practice Address - Phone:972-329-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36910122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist