Provider Demographics
NPI:1770679276
Name:SWEARINGEN, PURNIMA (DDSMSD)
Entity Type:Individual
Prefix:DR
First Name:PURNIMA
Middle Name:
Last Name:SWEARINGEN
Suffix:
Gender:F
Credentials:DDSMSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5931 PILGRIM WAY
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-2739
Mailing Address - Country:US
Mailing Address - Phone:262-886-0291
Mailing Address - Fax:
Practice Address - Street 1:4707 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1597
Practice Address - Country:US
Practice Address - Phone:262-658-8466
Practice Address - Fax:262-658-1277
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3419-0151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33478600Medicaid