Provider Demographics
NPI:1033164280
Name:SWARNA, BHAVANI (DDS)
Entity Type:Individual
Prefix:DR
First Name:BHAVANI
Middle Name:
Last Name:SWARNA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35102 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-1785
Mailing Address - Country:US
Mailing Address - Phone:734-728-8800
Mailing Address - Fax:734-728-3061
Practice Address - Street 1:35102 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-1785
Practice Address - Country:US
Practice Address - Phone:734-728-8800
Practice Address - Fax:734-728-3061
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0222261223G0001X
MI29010189101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4887078Medicaid