Provider Demographics
NPI:1124025002
Name:JOEL M SWITZER DDS PC
Entity type:Organization
Organization Name:JOEL M SWITZER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:MORELAND
Authorized Official - Last Name:SWITZER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-922-2542
Mailing Address - Street 1:3745 REYNOLDA RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-2241
Mailing Address - Country:US
Mailing Address - Phone:336-922-2542
Mailing Address - Fax:
Practice Address - Street 1:3745 REYNOLDA RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-2241
Practice Address - Country:US
Practice Address - Phone:336-922-2542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55764122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55764Medicaid