MEDICARE: ASMA AWAD D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN12584	FL

General Provider Information

NPI Number	:	1184939324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASMA AWAD D.D.S

Provider Business Mailing Address
First Line	:	3413 S KINGS AVE STE 200
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-7780
Country	:	US
Telephone Number	:	813-643-9029
Fax Number	:	813-643-9039

Provider Business Practice Location Address
First Line	:	3413 S KINGS AVE STE 200
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-7780
Country	:	US
Telephone Number	:	813-643-9029
Fax Number	:	813-643-9039

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2010
Last Update Date	:	08/12/2010

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Directions to “ ASMA AWAD D.D.S” Practice Location

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