Healthcare Provider Details

I. General information

NPI: 1316095417
Provider Name (Legal Business Name): THET SWE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 06/27/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10102 VALLEY VIEW ST
BUENA PARK CA
90620-4344
US

IV. Provider business mailing address

11365 ALTON DR
CORONA CA
92883-5230
US

V. Phone/Fax

Practice location:
  • Phone: 714-229-4898
  • Fax: 714-229-4899
Mailing address:
  • Phone: 310-750-5729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number50682
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: