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Organization
ELLY SWADIPURA DDS
Active
Organization
ELLY SWADIPURA DDS
Active
Parent organization
369 DENTAL CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
369 DENTAL CENTER
Authorized official
DR. ELLY SWADIPURA DDS (DENTIST OWNER)
(626) 962-2778
Entity
Organization
Contact information
Practice address
13105 RAMONA BLVD, SUITE A, IRWINDALE, CA 91706-3858
(626) 962-2778
(626) 338-8669
Mailing address
13105 RAMONA BLVD, SUITE A, IRWINDALE, CA 91706-3858
(626) 962-2778
(626) 338-8669
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D37508
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G90745-01
—
CA
Enumeration date
09/11/2014
Last updated
12/08/2014
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