Basic Information
| Provider Information | |||||||||
| NPI: | 1720055270 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | SWATI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1852 N MASTICK WAY | ||||||||
| Address2: | #1202 | ||||||||
| City: | NOGALES | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856211063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207612133 | ||||||||
| FaxNumber: | 5202812335 | ||||||||
| Practice Location | |||||||||
| Address1: | 1852 N MASTICK WAY | ||||||||
| Address2: | MARIPOSA COMMUNITY HEALTH CENTER | ||||||||
| City: | NOGALES | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856211063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202811550 | ||||||||
| FaxNumber: | 5202811112 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2006 | ||||||||
| LastUpdateDate: | 01/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | D5828 | AZ | Y | Dental Providers | Dentist | 1223D0001X | D5828 | AZ | N | Dental Providers | Dentist | Dental Public Health |
ID Information
| ID | Type | State | Issuer | Description | 812760 | 05 | AZ | MEDICAID |