Provider Demographics
NPI:1386805588
Name:SWASTY ORTHODONTICS, PA
Entity type:Organization
Organization Name:SWASTY ORTHODONTICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:CARROLL
Authorized Official - Last Name:SWASTY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:843-871-8700
Mailing Address - Street 1:1710 TROLLEY RD STE A
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8281
Mailing Address - Country:US
Mailing Address - Phone:843-871-8700
Mailing Address - Fax:843-277-0921
Practice Address - Street 1:1710 TROLLEY RD STE A
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8281
Practice Address - Country:US
Practice Address - Phone:843-871-8700
Practice Address - Fax:843-277-0921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4439261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental