MEDICARE: EMAD & KATERINA MOAWAD DENTAL CORP

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	49338	CA
2	1223G0001X	General Practice Dentistry	D48335	CA

General Provider Information

NPI Number	:	1770776767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMAD & KATERINA MOAWAD DENTAL CORP

Provider Business Mailing Address
First Line	:	4242 BEVERLY BLVD.
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004
Country	:	US
Telephone Number	:	213-384-8400
Fax Number	:	213-384-8484

Provider Business Practice Location Address
First Line	:	4242 BEVERLY BLVD.,
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004
Country	:	US
Telephone Number	:	213-384-8400
Fax Number	:	213-384-8484

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. EMAD FATHY MOAWAD
Credential	:	DDS
Telephone Number	:	213-384-8400

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	07/29/2008

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