Provider Demographics
NPI:1861872061
Name:SALEH KIWAN, AHMED (DMD)
Entity type:Individual
Prefix:DR
First Name:AHMED
Middle Name:
Last Name:SALEH KIWAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15201 ROYAL WINDSOR LN APT 403
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3904
Mailing Address - Country:US
Mailing Address - Phone:786-208-5174
Mailing Address - Fax:
Practice Address - Street 1:18990 S TAMIAMI TRL STE 110
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4737
Practice Address - Country:US
Practice Address - Phone:239-482-2296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21171122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist