Provider Demographics
NPI:1275191017
Name:SWISH DENTAL EAST PC
Entity Type:Organization
Organization Name:SWISH DENTAL EAST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIRAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:862-216-8108
Mailing Address - Street 1:501 WEST AVE APT 1004
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-2899
Mailing Address - Country:US
Mailing Address - Phone:862-216-8108
Mailing Address - Fax:
Practice Address - Street 1:1800 E 4TH ST UNIT 136
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-4543
Practice Address - Country:US
Practice Address - Phone:862-216-8108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-05
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental