Basic Information
| Provider Information | |||||||||
| NPI: | 1326511932 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALWAN & BADAWI DENTAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2451 JAMACHA ROAD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | EL CAJON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194440500 | ||||||||
| FaxNumber: | 6194442803 | ||||||||
| Practice Location | |||||||||
| Address1: | 2451 JAMACHA ROAD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | EL CAJON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194440500 | ||||||||
| FaxNumber: | 6194442803 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2019 | ||||||||
| LastUpdateDate: | 01/16/2019 | ||||||||
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| AuthorizedOfficialLastName: | ALWAN | ||||||||
| AuthorizedOfficialFirstName: | KHALED | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6194440500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.D.S. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist |
No ID Information.