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General NPI Number Information
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NPI Number | 1730739764
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Entity Type | Organization
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Legal Business Name | REGENESIS WELLNESS CENTER LLC
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Dates
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Enumeration Date | 09/11/2019
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Last Update Date | 09/11/2019
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Provider Practice Location Address
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Address Line | 4650 W JOJOBA DR
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City | TUCSON
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State | AZ
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Zip | 85745-9046
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Country | US
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Telephone | 520-743-3366
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 85490
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City | TUCSON
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State | AZ
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Zip | 85754-5490
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Country | US
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Telephone | 520-743-3366
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT/DENTIST
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Name | DR. STEVEN A SWIDLER
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Credential | DDS
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Telephone | 520-743-3366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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