Individual
LOGESH SWAYAMPRAKASAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1761 E CAPITOL EXPY, SAN JOSE, CA 95121-1561
(408) 484-3891
Mailing address
4688 MOWRY AVE, FREMONT, CA 94538-1148
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
100140
CA
1223P0300X
Periodontics
30-023111
OH
Other
Enumeration date
10/08/2009
Last updated
09/30/2022
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