Provider Demographics
NPI:1083988950
Name:SWAMINATHAN, VENKATESH TIRVUR (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:VENKATESH
Middle Name:TIRVUR
Last Name:SWAMINATHAN
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 COACHMANS CT
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1324
Mailing Address - Country:US
Mailing Address - Phone:347-350-3889
Mailing Address - Fax:
Practice Address - Street 1:12 COACHMANS CT
Practice Address - Street 2:
Practice Address - City:OLD WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11568-1324
Practice Address - Country:US
Practice Address - Phone:347-350-3889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055944122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist