Provider Demographics
NPI:1235021882
Name:AWAN, MUHAMMAD AZZAM (DMD)
Entity type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:AZZAM
Last Name:AWAN
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 1:10560 WOODCHASE CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-5872
Mailing Address - Country:US
Mailing Address - Phone:407-451-2301
Mailing Address - Fax:
Practice Address - Street 1:1900 S FERDON BLVD STE 170
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-8510
Practice Address - Country:US
Practice Address - Phone:850-641-8887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN30709122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist