Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | 8225 | NC |
Y | 1223G0001X | General Practice | 8225 | NC |
Y | 213EG0000X | General Practice | 8225 | NC |
NPI | 1013065796 |
---|---|
Provider Name | Dr. Tiky Kytasha Swain |
First Address | Charlotte, NC 28262-1344 |
Second Address | Charlotte, NC 28262-1344 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 23/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5904063 | (05) | NC |