Provider Demographics
NPI:1992262547
Name:KIWAN DENTAL CARE & DENTAL IMPLANTS CENTER, LLC
Entity type:Organization
Organization Name:KIWAN DENTAL CARE & DENTAL IMPLANTS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:M
Authorized Official - Last Name:SALEH KIWAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:239-313-7770
Mailing Address - Street 1:5285 SUMMERLIN RD STE 401
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-7601
Mailing Address - Country:US
Mailing Address - Phone:239-313-7770
Mailing Address - Fax:
Practice Address - Street 1:5285 SUMMERLIN RD STE 401
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-7601
Practice Address - Country:US
Practice Address - Phone:239-313-7770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental