Healthcare Provider Details

I. General information

NPI: 1295244028
Provider Name (Legal Business Name): M K AWWAD DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33050 ANTELOPE RD STE 207
MURRIETA CA
92563-2491
US

IV. Provider business mailing address

33050 ANTELOPE RD STE 207
MURRIETA CA
92563-2491
US

V. Phone/Fax

Practice location:
  • Phone: 951-672-6700
  • Fax: 951-672-6200
Mailing address:
  • Phone: 951-672-6700
  • Fax: 951-672-6200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number46741
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number46741
License Number StateCA

VIII. Authorized Official

Name: MAHER K AWWAD
Title or Position: C.E.O. / DENTIST
Credential: DDS
Phone: 951-315-7033