Healthcare Provider Details

I. General information

NPI: 1780869305
Provider Name (Legal Business Name): GAMILA MIMI AWAYES D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600B PINECREST OFFICE PARK DR
ALEXANDRIA VA
22312-1460
US

IV. Provider business mailing address

4600B PINECREST OFFICE PARK DR
ALEXANDRIA VA
22312-1460
US

V. Phone/Fax

Practice location:
  • Phone: 703-914-0020
  • Fax:
Mailing address:
  • Phone: 703-914-0020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401007837
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: