Provider Demographics
NPI:1740648674
Name:SWAPNA RAVEENDRANATH DENTAL CORPORATION
Entity type:Organization
Organization Name:SWAPNA RAVEENDRANATH DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SWAPNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVEENDRANATH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-371-2502
Mailing Address - Street 1:39055 HASTINGS ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1518
Mailing Address - Country:US
Mailing Address - Phone:510-791-3144
Mailing Address - Fax:510-791-3140
Practice Address - Street 1:39055 HASTINGS ST
Practice Address - Street 2:SUITE 203
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1518
Practice Address - Country:US
Practice Address - Phone:510-791-3144
Practice Address - Fax:510-791-3140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-06
Last Update Date:2016-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56777302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization