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NPI Code Detail

MEDICARE: TALA AL AWWAD

MEDICARE: TALA AL AWWAD
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
1122300000XDentist8235OK

General Provider Information

NPI Number : 1457210494
Entity Type Code : Individual
Provider Name (Legal Business Name) : TALA AL AWWAD
Provider Business Mailing Address
First Line : 213 W CIVIC CENTER DR APT 328
Second Line :
City : SANDY
State : UT
Zip : 84070-1235
Country : US
Telephone Number : 805-453-7664
Fax Number :
Provider Business Practice Location Address
First Line : 1829 S WOOD DR
Second Line :
City : OKMULGEE
State : OK
Zip : 74447-6825
Country : US
Telephone Number : 918-756-6500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2026
Last Update Date : 05/07/2026

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Directions to “ TALA AL AWWAD ” Practice Location

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