Provider Demographics
NPI:1699127563
Name:SWARTHMORE DENTAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:SWARTHMORE DENTAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:MINSK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-328-4815
Mailing Address - Street 1:801 YALE AVE
Mailing Address - Street 2:SUITE 619
Mailing Address - City:SWARTHMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19081-1808
Mailing Address - Country:US
Mailing Address - Phone:610-328-4817
Mailing Address - Fax:
Practice Address - Street 1:801 YALE AVE
Practice Address - Street 2:SUITE 619
Practice Address - City:SWARTHMORE
Practice Address - State:PA
Practice Address - Zip Code:19081-1808
Practice Address - Country:US
Practice Address - Phone:610-328-4817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028124L261QD0000X
PADS029928L261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental