Provider Demographics
NPI:1952568040
Name:AWAD, ANGEL MAKEN (DDS)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:MAKEN
Last Name:AWAD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 ANIZUMNE CT
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:CA
Mailing Address - Zip Code:94517-1230
Mailing Address - Country:US
Mailing Address - Phone:925-524-0264
Mailing Address - Fax:
Practice Address - Street 1:702 ANIZUMNE CT
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:CA
Practice Address - Zip Code:94517-1230
Practice Address - Country:US
Practice Address - Phone:925-524-0264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-17
Last Update Date:2008-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56966122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist