Individual
DR. REVANA EMAD AWADALLAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
29663 GATEWAY AVE, CHISAGO CITY, MN 55013-0339
(651) 257-3639
Mailing address
7741 WINTER WHEAT WAY, WOODBURY, MN 55129-2401
(651) 274-7561
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D14808
MN
Other
Enumeration date
07/13/2022
Last updated
07/13/2022
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