Organization
SWAN ORAL & FACIAL SURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUSHI PATEL DDS (OWNER)
(863) 688-1537
Entity
Organization
Contact information
Practice address
407 S KENTUCKY AVE, LAKELAND, FL 33801-5301
(863) 688-1537
(863) 687-3418
Mailing address
407 S KENTUCKY AVE, LAKELAND, FL 33801-5301
(863) 688-1537
(863) 687-3418
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN17708
STATE LICENSE
FL
Enumeration date
01/22/2020
Last updated
01/22/2020
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