Provider Demographics
NPI:1346687563
Name:RADWAN, AMR HESHAM AHMED
Entity type:Individual
Prefix:DR
First Name:AMR
Middle Name:HESHAM AHMED
Last Name:RADWAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6115 STIRLING RD
Mailing Address - Street 2:SUITE# 213
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-7241
Mailing Address - Country:US
Mailing Address - Phone:954-791-3277
Mailing Address - Fax:
Practice Address - Street 1:6115 STIRLING RD
Practice Address - Street 2:SUITE# 213
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-7241
Practice Address - Country:US
Practice Address - Phone:954-791-3277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX289801223E0200X
FL216081223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics