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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