Provider Demographics
NPI:1427320530
Name:MOAWAD, MICHAEL M (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:M
Last Name:MOAWAD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 CARHART CT
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1864
Mailing Address - Country:US
Mailing Address - Phone:732-284-9760
Mailing Address - Fax:
Practice Address - Street 1:2695 ROUTE 516
Practice Address - Street 2:2ND FLOOR. SUITE 5
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2319
Practice Address - Country:US
Practice Address - Phone:732-607-1337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-04
Last Update Date:2012-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02475400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist