Healthcare Provider Details

I. General information

NPI: 1861872061
Provider Name (Legal Business Name): AHMED SALEH KIWAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18990 S TAMIAMI TRL STE 110
FORT MYERS FL
33908-4737
US

IV. Provider business mailing address

15201 ROYAL WINDSOR LN APT 403
FORT MYERS FL
33919-3904
US

V. Phone/Fax

Practice location:
  • Phone: 239-482-2296
  • Fax:
Mailing address:
  • Phone: 786-208-5174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN21171
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: