Provider Demographics
NPI:1871931659
Name:SW MOBILE DA
Entity type:Organization
Organization Name:SW MOBILE DA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:BROWNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-652-6958
Mailing Address - Street 1:13575 W INDIAN SCHOOL RD
Mailing Address - Street 2:STE #1000
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-4901
Mailing Address - Country:US
Mailing Address - Phone:480-652-6958
Mailing Address - Fax:424-230-7849
Practice Address - Street 1:13575 W INDIAN SCHOOL RD
Practice Address - Street 2:STE #1000
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4901
Practice Address - Country:US
Practice Address - Phone:480-652-6958
Practice Address - Fax:424-230-7849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD5164261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental