MEDICARE: DR. ERIC D SWANSON M.D.,D.M.D.

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	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	9150	NV
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	9150	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780776781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC D SWANSON M.D.,D.M.D.

Provider Business Mailing Address
First Line	:	2030 E FLAMINGO RD
Second Line	:	288
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-0818
Country	:	US
Telephone Number	:	702-892-0833
Fax Number	:	702-892-0906

Provider Business Practice Location Address
First Line	:	2030 E FLAMINGO RD
Second Line	:	288
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-0818
Country	:	US
Telephone Number	:	702-892-0833
Fax Number	:	702-892-0906

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	02/23/2010

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