Provider Demographics
NPI:1154472892
Name:TAILOR, SWETA (DDS)
Entity Type:Individual
Prefix:
First Name:SWETA
Middle Name:
Last Name:TAILOR
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 1:4105 MEDICAL PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756
Mailing Address - Country:US
Mailing Address - Phone:512-458-1133
Mailing Address - Fax:512-458-1135
Practice Address - Street 1:4105 MEDICAL PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756
Practice Address - Country:US
Practice Address - Phone:512-458-1133
Practice Address - Fax:512-458-1135
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice