MEDICARE: RADWAN ENDODONTIC PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics

General Provider Information

NPI Number	:	1649004110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADWAN ENDODONTIC PLLC

Provider Business Mailing Address
First Line	:	6115 STIRLING RD STE 213
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33314-7240
Country	:	US
Telephone Number	:	954-791-3277
Fax Number	:	954-374-4424

Provider Business Practice Location Address
First Line	:	6115 STIRLING RD STE 213
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33314-7240
Country	:	US
Telephone Number	:	954-791-3277
Fax Number	:	954-374-4424

Authorized Official
Title or Position	:	ENDODONTIST
Name	:	DR. AMR RADWAN
Credential	:	DDS
Telephone Number	:	954-791-3277

Provider Enumeration Date	:	08/28/2024
Last Update Date	:	08/28/2024

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