Provider Demographics
NPI:1376698738
Name:SOUTHWEST FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:SOUTHWEST FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:ENGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-276-1661
Mailing Address - Street 1:6724 PERIMETER LOOP RD # 312
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3202
Mailing Address - Country:US
Mailing Address - Phone:614-276-1661
Mailing Address - Fax:614-276-1664
Practice Address - Street 1:699 HARRISBURG PIKE
Practice Address - Street 2:SUITE N-P
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-2141
Practice Address - Country:US
Practice Address - Phone:614-276-1661
Practice Address - Fax:614-276-1664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300185761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0701413Medicaid