MEDICARE: DR. THERESE MURPHY-SWANSON DDS

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	122300000X	Dentist	19020748	IL

General Provider Information

NPI Number	:	1578608402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERESE MURPHY-SWANSON DDS

Provider Business Mailing Address
First Line	:	307 S HOBBLEBUSH LANE
Second Line	:
City	:	VERNON HILLS
State	:	IL
Zip	:	60061
Country	:	US
Telephone Number	:	847-913-5508
Fax Number	:	847-913-5508

Provider Business Practice Location Address
First Line	:	685 GRACELAND AVE
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60016-4518
Country	:	US
Telephone Number	:	847-824-3536
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	06/22/2012

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