Healthcare Provider Details

I. General information

NPI: 1194219659
Provider Name (Legal Business Name): CJSWIHART, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12725 MCMANUS BLVD STE 1B
NEWPORT NEWS VA
23602-4402
US

IV. Provider business mailing address

12725 MCMANUS BLVD STE 1B
NEWPORT NEWS VA
23602-4402
US

V. Phone/Fax

Practice location:
  • Phone: 757-874-0990
  • Fax:
Mailing address:
  • Phone: 757-874-0990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401416033
License Number StateVA

VIII. Authorized Official

Name: DR. CORRIE JEAN SWIHART
Title or Position: ORTHODONTIST
Credential: DDS, MSD
Phone: 574-952-6325