Healthcare Provider Details

I. General information

NPI: 1609702273
Provider Name (Legal Business Name): SWATHI VANGIPURAM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10320 W MCDOWELL RD STE 1001
AVONDALE AZ
85392-4865
US

IV. Provider business mailing address

9813 W MONTEREY WAY
PHOENIX AZ
85037-0062
US

V. Phone/Fax

Practice location:
  • Phone: 623-242-6001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD012867
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: