MEDICARE: CLIFFORD J SWANSON DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019018072	IL

General Provider Information

NPI Number	:	1376616607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLIFFORD J SWANSON DDS PC

Provider Business Mailing Address
First Line	:	1077 HOLLI CT
Second Line	:
City	:	SCHAUMBURG
State	:	IL
Zip	:	60194-4274
Country	:	US
Telephone Number	:	847-884-8876
Fax Number	:	847-884-8876

Provider Business Practice Location Address
First Line	:	2215 W SCHAUMBURG RD
Second Line	:
City	:	SCHAUMBURG
State	:	IL
Zip	:	60194-3891
Country	:	US
Telephone Number	:	847-352-5410
Fax Number	:	847-352-1809

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CLIFFORD J SWANSON
Credential	:	D.D.S.
Telephone Number	:	847-884-8876

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	01/27/2014

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