Provider Demographics
NPI:1730739764
Name:REGENESIS WELLNESS CENTER LLC
Entity type:Organization
Organization Name:REGENESIS WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SWIDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-743-3366
Mailing Address - Street 1:PO BOX 85490
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85754-5490
Mailing Address - Country:US
Mailing Address - Phone:520-743-3366
Mailing Address - Fax:
Practice Address - Street 1:4650 W JOJOBA DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-9046
Practice Address - Country:US
Practice Address - Phone:520-743-3366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty