Provider Demographics
NPI:1720658859
Name:ZINELDINE, REWAN AMAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:REWAN
Middle Name:AMAD
Last Name:ZINELDINE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13706 W BELL RD STE 2
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-3556
Mailing Address - Country:US
Mailing Address - Phone:623-584-9910
Mailing Address - Fax:
Practice Address - Street 1:13706 W BELL RD STE 2
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3556
Practice Address - Country:US
Practice Address - Phone:623-584-9910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002047761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice