SWAN ORAL & FACIAL SURGERY, LLC (NPI# 1073143731) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073143731 |
| Entity Type | Organization |
| Organization Name | SWAN ORAL & FACIAL SURGERY, LLC |
| Practice Address |
407 S Kentucky Ave Lakeland FL 33801-5301 |
| Practice Telephone | 8636881537 |
| Practice Fax Number | 8636873418 |
| Mailing Telephone | 8636881537 |
| Mailing Fax Number | 8636873418 |
| Enumeration Date | 2020-01-22 |
| Last Update Date | 2020-01-22 |
| Authorized Official Name | RUSHI PATEL (OWNER) |
| Authorized Official Telephone | 8636881537 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QS0112X |
Clinic/Center Specialization: Oral and Maxillofacial Surgery |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | STATE LICENSE | DN17708 | 01 |
| Street Address |
407 S KENTUCKY AVE |
| City | LAKELAND |
| State | FL |
| Zip Code | 33801-5301 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710093604 | Lawrence Kerwin Cook | Dentist | 407 S Kentucky Ave, Lakeland, FL 33801 | 2006-08-22 |
| 1912319302 | Jason Jaisung Cho | Dentist | 407 S Kentucky Ave, Lakeland, FL 33801-5301 | 2014-05-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508473802 | Camryn Nichole White | Assistant Behavior Analyst | 301 South Florida Ave, Lakeland, FL 33801 | 2020-09-30 |
| 1932719242 | Jimia Watkins | Home Health Aide | 2410 Lakeview St, Lakeland, FL 33801 | 2020-08-03 |
| 1396366886 | Erin Zimmer | Health Educator | 491 Lake Parker Ave, Lakeland, FL 33801 | 2020-05-06 |
| 1013473206 | Madelyn Claire Burley | Occupational Therapist | 1215 East Orange Street, Lakeland, FL 33801 | 2019-02-13 |
| 1992260319 | Publix Super Markets, Inc. | Durable Medical Equipment & Medical Supplies | 1617 Us Highway 98 S, Lakeland, FL 33801 | 2019-02-11 |
| 1669908836 | Integrative Physical Medicine of Lakeland LLC | Specialist | 1205 East Magnolia St, Suite 105, Lakeland, FL 33801 | 2017-05-10 |
| 1689111502 | Daryl Dowding | Counselor | 390 Alcaia Rd., Lakeland, FL 33801 | 2017-01-30 |
| 1023481926 | Joseph D'alessandro | Specialist/Technologist | 111 Lake Hollingsworth Dr Box 4334, Lakeland, FL 33801 | 2015-11-02 |
| 1588030894 | Donna Lee Buckner | Specialist/Technologist | 111 Mosswood Road, Lakeland, FL 33801 | 2015-08-20 |
| 1144635780 | Donna Paige Mccraney | Nurse Practitioner | 111 Lake Hollingsworth Drive, Florida Southern College Student Health Center, Lakeland, FL 33801 | 2014-06-23 |
| Find all providers in zip 33801 | ||||
| Taxonomy Code | 261QS0112X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447875968 | Aq Surgery LLC | Clinic/Center | 14050 Integra Dr Apt 1134, Jacksonville, FL 32218-2666 | 2020-06-10 |
| 1568095255 | Broward Oral Surgery Pa | Clinic/Center | 3157 N University Dr Ste 104, Pembroke Pines, FL 33024-2258 | 2020-02-20 |
| 1497221352 | Ac O&m Services LLC | Clinic/Center | 4675 Van Dyke Rd, Lutz, FL 33558-4880 | 2018-10-18 |
| 1326549080 | Dental Designs of Naples LLC | Clinic/Center | 5048 Tamiami Trl N Ste A, Naples, FL 34103-2836 | 2018-02-27 |
| 1407395361 | Barry C Levine Dmd Pa | Clinic/Center | 5212 E Fowler Ave, Temple Terrace, FL 33617-2147 | 2017-02-13 |
| 1760722474 | Oral and Facial Surgery of Florida, Inc. | Clinic/Center | 19051 Us Highway 441, Suite 104, Mount Dora, FL 32757-6708 | 2013-02-18 |
| 1316211196 | Trevisani Oral Surgery | Clinic/Center | 511 Wekiva Commons Cir, Apopka, FL 32712-3645 | 2012-02-27 |
| 1386957744 | Regina H. Saenz, Dds, Pa | Clinic/Center | 950 N Krome Ave Ste 204, Homestead, FL 33030-4455 | 2010-07-14 |
| 1598883043 | Philip Marciano, M.d., P.a. | Clinic/Center | 9975 Tamiami Trl N, #4, Naples, FL 34108-1942 | 2007-03-26 |
| 1780150938 | Jose Luis Beltran Dmd Md LLC | Clinic/Center | 11424 N 56th St, Temple Terrace, FL 33617-2237 | 2018-10-15 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.