Provider Demographics
NPI:1285871616
Name:AT TAWHEED DENTAL CORP
Entity type:Organization
Organization Name:AT TAWHEED DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FADI
Authorized Official - Middle Name:
Authorized Official - Last Name:KABLAWI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-776-7222
Mailing Address - Street 1:12885 PINE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2418
Mailing Address - Country:US
Mailing Address - Phone:305-776-7222
Mailing Address - Fax:
Practice Address - Street 1:888 NE 126TH ST
Practice Address - Street 2:203
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-4964
Practice Address - Country:US
Practice Address - Phone:305-893-0902
Practice Address - Fax:305-248-7717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17359261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental