Provider Demographics
NPI:1730853664
Name:AWNALLAH, AZIZA (DMD/ DDS)
Entity type:Individual
Prefix:
First Name:AZIZA
Middle Name:
Last Name:AWNALLAH
Suffix:
Gender:F
Credentials:DMD/ DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 BEVERLY ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-2615
Mailing Address - Country:US
Mailing Address - Phone:510-283-4662
Mailing Address - Fax:
Practice Address - Street 1:38056 MARTHA AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-3809
Practice Address - Country:US
Practice Address - Phone:510-505-9453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS106625122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist