Provider Demographics
NPI:1750448692
Name:STEVEN A SWIDLER DDS PC
Entity Type:Organization
Organization Name:STEVEN A SWIDLER DDS PC
Other - Org Name:MEDICINE WHEEL DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:SWIDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-743-7101
Mailing Address - Street 1:PO BOX 85490
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85754
Mailing Address - Country:US
Mailing Address - Phone:520-743-7101
Mailing Address - Fax:520-743-0450
Practice Address - Street 1:4650 W JOJOBA DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-9046
Practice Address - Country:US
Practice Address - Phone:520-743-7101
Practice Address - Fax:520-743-0450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ1970122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty