| NPI | 1992899488 |
|---|---|
| Former Legal Business Name | DENTAL PROFESSIONALS OF MARYLAND, GERALD AWADZI, P.C. |
| Doing Business As | OLDE TOWN LAUREL DENTAL |
| Entity Type | Organization |
| Authorized Contact | TABATHA LEMKE Credentialing Coordinator 217-540-6078 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 10680) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2021-06-07 |