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Organization
DENTAL WHITE MANAGEMENT LLC
Active
Organization
DENTAL WHITE MANAGEMENT LLC
Active
Other names
Seaside Perio Centre
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LOGESH SWAYAMPRAKASAM BDS,MPH, MS (PERIODONTIST)
(224) 877-0645
Entity
Organization
Contact information
Practice address
43625 MISSION BLVD STE 105, FREMONT, CA 94539-5800
(669) 245-7494
Mailing address
3680 BEACON AVE APT 320, FREMONT, CA 94538-3046
(224) 877-0645
(669) 265-0400
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DDS100140
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215262225
—
OH
Enumeration date
04/30/2018
Last updated
04/30/2018
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