MEDICARE: DALIA AL-AZZAWI DMD

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	122300000X	Dentist	DN21297	FL

General Provider Information

NPI Number	:	1952782989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALIA AL-AZZAWI DMD

Provider Business Mailing Address
First Line	:	5905 SE FEDERAL HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-7871
Country	:	US
Telephone Number	:	772-283-5360
Fax Number	:	772-283-5361

Provider Business Practice Location Address
First Line	:	5905 SE FEDERAL HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-7871
Country	:	US
Telephone Number	:	772-283-5360
Fax Number	:	772-283-5361

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

Provider Enumeration Date	:	06/16/2015
Last Update Date	:	06/16/2015

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