Provider Demographics
NPI:1508890799
Name:DR. KEVIN SWARTZBERG DENTAL CORPORATION
Entity Type:Organization
Organization Name:DR. KEVIN SWARTZBERG DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWARTZBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-463-9931
Mailing Address - Street 1:3050 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-2426
Mailing Address - Country:US
Mailing Address - Phone:619-463-9931
Mailing Address - Fax:619-463-9317
Practice Address - Street 1:3050 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-2426
Practice Address - Country:US
Practice Address - Phone:619-463-9931
Practice Address - Fax:619-463-9317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA398951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty