Provider Demographics
NPI:1235596081
Name:SOUTHWEST GD DENTAL CORP
Entity Type:Organization
Organization Name:SOUTHWEST GD DENTAL CORP
Other - Org Name:SOUTHWEST DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:DELSNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-730-1857
Mailing Address - Street 1:6601 S RURAL RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3747
Mailing Address - Country:US
Mailing Address - Phone:480-730-1857
Mailing Address - Fax:480-831-0702
Practice Address - Street 1:6601 S RURAL RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3747
Practice Address - Country:US
Practice Address - Phone:480-730-1857
Practice Address - Fax:480-831-0702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty