MEDICARE: KIWAN DENTAL CARE & DENTAL IMPLANTS CENTER, LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1992262547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIWAN DENTAL CARE & DENTAL IMPLANTS CENTER, LLC

Provider Business Mailing Address
First Line	:	5285 SUMMERLIN RD STE 401
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-7601
Country	:	US
Telephone Number	:	239-313-7770
Fax Number	:

Provider Business Practice Location Address
First Line	:	5285 SUMMERLIN RD STE 401
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-7601
Country	:	US
Telephone Number	:	239-313-7770
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/ DIRECTOR
Name	:	DR. AHMED M SALEH KIWAN
Credential	:	D.M.D
Telephone Number	:	239-313-7770

Provider Enumeration Date	:	03/01/2019
Last Update Date	:	03/01/2019

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