Healthcare Provider Details

I. General information

NPI: 1720658859
Provider Name (Legal Business Name): REWAN AMAD ZINELDINE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13706 W BELL RD STE 2
SURPRISE AZ
85374-3556
US

IV. Provider business mailing address

13706 W BELL RD STE 2
SURPRISE AZ
85374-3556
US

V. Phone/Fax

Practice location:
  • Phone: 623-584-9910
  • Fax:
Mailing address:
  • Phone: 623-584-9910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN.00204776
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: