Provider Demographics
NPI:1013100387
Name:4TH AVENUE FAMILY DENTISTRY, LLC
Entity type:Organization
Organization Name:4TH AVENUE FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SWAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-333-0771
Mailing Address - Street 1:390 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-4125
Mailing Address - Country:US
Mailing Address - Phone:303-333-0771
Mailing Address - Fax:303-333-0779
Practice Address - Street 1:390 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-4125
Practice Address - Country:US
Practice Address - Phone:303-333-0771
Practice Address - Fax:303-333-0779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty