MEDICARE: E.MOAWAD DENTAL CORPORATION

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	302F00000X	Exclusive Provider Organization	DDS48335	CA

General Provider Information

NPI Number	:	1841735511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E.MOAWAD DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	402 S LONG BEACH BLVD
Second Line	:
City	:	COMPTON
State	:	CA
Zip	:	90221-3428
Country	:	US
Telephone Number	:	310-537-7615
Fax Number	:	310-537-7659

Provider Business Practice Location Address
First Line	:	402 S LONG BEACH BLVD
Second Line	:
City	:	COMPTON
State	:	CA
Zip	:	90221-3428
Country	:	US
Telephone Number	:	310-537-7615
Fax Number	:	310-537-7659

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. GABRIELA CASTILLO
Credential	:
Telephone Number	:	310-537-7615

Provider Enumeration Date	:	01/04/2017
Last Update Date	:	01/04/2017

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Directions to “E.MOAWAD DENTAL CORPORATION ” Practice Location

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