Healthcare Provider Details

I. General information

NPI: 1215648860
Provider Name (Legal Business Name): SUKAYNAH HADI ALAWAMI DDS,MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5328 COLDWATER RD
FORT WAYNE IN
46825-5445
US

IV. Provider business mailing address

13909 STONE TABLE BLVD
FORT WAYNE IN
46845-0149
US

V. Phone/Fax

Practice location:
  • Phone: 260-471-5016
  • Fax:
Mailing address:
  • Phone: 312-929-7366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12013969A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: