Provider Demographics
NPI:1649004110
Name:RADWAN ENDODONTIC PLLC
Entity type:Organization
Organization Name:RADWAN ENDODONTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMR
Authorized Official - Middle Name:
Authorized Official - Last Name:RADWAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-791-3277
Mailing Address - Street 1:6115 STIRLING RD STE 213
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-7240
Mailing Address - Country:US
Mailing Address - Phone:954-791-3277
Mailing Address - Fax:954-374-4424
Practice Address - Street 1:6115 STIRLING RD STE 213
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-7240
Practice Address - Country:US
Practice Address - Phone:954-791-3277
Practice Address - Fax:954-374-4424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty