Provider Demographics
NPI:1336635051
Name:ALWALIE, AMNA (DMD)
Entity type:Individual
Prefix:
First Name:AMNA
Middle Name:
Last Name:ALWALIE
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 57TH AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-4925
Mailing Address - Country:US
Mailing Address - Phone:262-654-6800
Mailing Address - Fax:
Practice Address - Street 1:3620 57TH AVE STE 600
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-4925
Practice Address - Country:US
Practice Address - Phone:262-654-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-05
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001558-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty