Provider Demographics
NPI:1790034700
Name:S M KIWAN, DDS, INC
Entity Type:Organization
Organization Name:S M KIWAN, DDS, INC
Other - Org Name:HIGH SIERRA DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER/OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALEEM
Authorized Official - Middle Name:M
Authorized Official - Last Name:KIWAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-224-3110
Mailing Address - Street 1:4820 N. 1ST STREET
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-0522
Mailing Address - Country:US
Mailing Address - Phone:559-224-3110
Mailing Address - Fax:559-227-7752
Practice Address - Street 1:4820 N. 1ST STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-0522
Practice Address - Country:US
Practice Address - Phone:559-224-3110
Practice Address - Fax:559-227-7752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA504111223G0001X, 261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty