| Seaside Perio Centre | |
|
43625 Mission Blvd Ste 105 Fremont CA 94539-5800 | |
| (669) 245-7494 | |
| Not Available |
| Full Name | Seaside Perio Centre |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 43625 Mission Blvd Ste 105, Fremont, California |
| Authorized Official Name and Position | Logesh Swayamprakasam (PERIODONTIST) |
| Authorized Official Contact | 2248770645 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Seaside Perio Centre 3680 Beacon Ave Apt 320 Fremont CA 94538-3046 Ph: (224) 877-0645 | Seaside Perio Centre 43625 Mission Blvd Ste 105 Fremont CA 94539-5800 Ph: (669) 245-7494 |
| NPI Number | 1457849960 |
|---|---|
| Provider Enumeration Date | 04/30/2018 |
| Last Update Date | 04/30/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457849960 | NPI | - | NPPES |
| 1215262225 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | DDS100140 (California) | Primary |
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