Healthcare Provider Details

I. General information

NPI: 1780139410
Provider Name (Legal Business Name): SWATI GANDLURI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 W BROAD ST
BETHLEHEM PA
18018-5024
US

IV. Provider business mailing address

2168 NATOMA PL
MANTECA CA
95337-8137
US

V. Phone/Fax

Practice location:
  • Phone: 806-543-7376
  • Fax: 484-892-6240
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS044717
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: