Provider Demographics
NPI:1568553931
Name:SW DENTAL RECONSTRUCTION GROUP
Entity Type:Organization
Organization Name:SW DENTAL RECONSTRUCTION GROUP
Other - Org Name:VILLAGE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/SENIOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-922-1045
Mailing Address - Street 1:110 ESTES WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOT SPRINGS VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71909-7789
Mailing Address - Country:US
Mailing Address - Phone:501-922-1045
Mailing Address - Fax:501-922-6217
Practice Address - Street 1:110 ESTES WAY
Practice Address - Street 2:SUITE A
Practice Address - City:HOT SPRINGS VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71909-7789
Practice Address - Country:US
Practice Address - Phone:501-922-1045
Practice Address - Fax:501-922-6217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Not Answered124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty