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General NPI Number Information
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NPI Number | 1588118434
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Entity Type | Organization
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Legal Business Name | SWANA DENTAL DELIVERY
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Dates
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Enumeration Date | 08/09/2016
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Last Update Date | 08/09/2016
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Provider Practice Location Address
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Address Line | 6299 UNIVERSITY AVE NE SUITE100
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City | FRIDLEY
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State | MN
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Zip | 55432-4918
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Country | US
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Telephone | 612-250-8515
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Fax |
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Provider Business Mailing Address
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Address Line | 6299 UNIVERSITY AVE NE SUITE100
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City | FRIDLEY
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State | MN
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Zip | 55432-4918
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Country | US
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Telephone | 612-250-8515
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | GAURANG BHATT
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Credential | DDS
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Telephone | 612-250-8515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | D12197
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License Number State | MN
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