Provider Demographics
NPI:1578668372
Name:DAWOUD, MEDHAT (DMD)
Entity type:Individual
Prefix:DR
First Name:MEDHAT
Middle Name:
Last Name:DAWOUD
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 1:667 EAGLE ROCK AVENUE
Mailing Address - Street 2:SECOND FLOOR, STE B
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2177
Mailing Address - Country:US
Mailing Address - Phone:973-731-2000
Mailing Address - Fax:973-731-2211
Practice Address - Street 1:667 EAGLE ROCK AVENUE
Practice Address - Street 2:SECOND FLOOR, STE B
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2177
Practice Address - Country:US
Practice Address - Phone:973-731-2000
Practice Address - Fax:973-731-2211
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022776001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice