Provider Demographics
NPI:1124472139
Name:ALWANNI, NADA (DMD, MS)
Entity type:Individual
Prefix:
First Name:NADA
Middle Name:
Last Name:ALWANNI
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9180 LEDGEMONT DR
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-4027
Mailing Address - Country:US
Mailing Address - Phone:717-829-6739
Mailing Address - Fax:
Practice Address - Street 1:2124 CORNELL RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-3804
Practice Address - Country:US
Practice Address - Phone:216-368-3102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRES.36651223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery