Dental White Management LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

DDS100140 Issued in CA

Legal business name

DENTAL WHITE MANAGEMENT LLC

Doing business as

Seaside Perio Centre

Practice address

43625 Mission Blvd Ste 105
Fremont, CA 94539-5800

Phone

(669) 245-7494

NPI assigned

Apr 30, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Logesh Swayamprakasam, BDS,MPH, MS

Title

Periodontist

Phone

(224) 877-0645

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Seaside Perio Centre Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1525046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525046400000",
    "number": "1457849960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3680 BEACON AVE APT 320",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945383046",
            "telephone_number": "224-877-0645",
            "fax_number": "669-265-0400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43625 MISSION BLVD STE 105",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945395800",
            "telephone_number": "669-245-7494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL WHITE MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-30",
        "last_updated": "2018-04-30",
        "status": "A",
        "authorized_official_last_name": "SWAYAMPRAKASAM",
        "authorized_official_first_name": "LOGESH",
        "authorized_official_title_or_position": "PERIODONTIST",
        "authorized_official_telephone_number": "224-877-0645",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "BDS,MPH, MS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CA",
            "license": "DDS100140",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215262225",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Seaside Perio Centre",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alyssa J Deneal
• Lawrence Dennen Jr., MD
• Kimberly Denny, PA-C
• Dental Corporation of Mokbil and Gill
• Dental Group of Dong Shin, DDS, Inc.
• Dentist
• Gurleen Deol, PA
• Sandeep Kaur Deol, MD
• Department of Veterans Affairs
• Alma Depizzo, FNP

• Dental Clinic/Center in Fremont, CA
• Providers in Fremont, CA by specialty
• Dental Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.