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General NPI Number Information
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NPI Number | 1477297836
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Entity Type | Individual
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Provider Name | DEENA AL-AAWAH
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Gender | Female
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Dates
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Enumeration Date | 04/22/2022
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Last Update Date | 04/30/2024
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Provider Practice Location Address
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Address Line | 12612 CAPITAL BLVD STE 100
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City | WAKE FOREST
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State | NC
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Zip | 27587-7489
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Country | US
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Telephone | 919-435-3313
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Fax |
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Provider Business Mailing Address
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Address Line | 780 JACOBS WAY
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City | CANTONMENT
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State | FL
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Zip | 32533-7897
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Country | US
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Telephone | 251-359-4338
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12883
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4669
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License Number State | WV
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