Provider Demographics
NPI:1346626587
Name:FORSYTH COUNTY DBA CLEVELAND AVENUE DENTAL CENTER
Entity Type:Organization
Organization Name:FORSYTH COUNTY DBA CLEVELAND AVENUE DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:SWIFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-703-3117
Mailing Address - Street 1:501 N CLEVELAND AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-4366
Mailing Address - Country:US
Mailing Address - Phone:336-703-3101
Mailing Address - Fax:
Practice Address - Street 1:501 N CLEVELAND AVE STE 1
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-4366
Practice Address - Country:US
Practice Address - Phone:336-703-3101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORSYTH COUNTY DBA DEPARTMENT OF PUBLIC HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-10
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404334Medicaid