Healthcare Provider Details

I. General information

NPI: 1518642297
Provider Name (Legal Business Name): MARINA AWAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1462 W GRANADA BLVD STE 210
ORMOND BEACH FL
32174-9167
US

IV. Provider business mailing address

4000 PRESIDENTIAL BLVD APT 1120
PHILADELPHIA PA
19131-1721
US

V. Phone/Fax

Practice location:
  • Phone: 386-675-1711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN28871
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: