Healthcare Provider Details

I. General information

NPI: 1275975393
Provider Name (Legal Business Name): SWANSON DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 ROSS AVE STE 302
SAN JOSE CA
95124-3038
US

IV. Provider business mailing address

3535 ROSS AVE STE 302
SAN JOSE CA
95124-3038
US

V. Phone/Fax

Practice location:
  • Phone: 408-265-6501
  • Fax: 408-265-6502
Mailing address:
  • Phone: 408-265-6501
  • Fax: 408-265-6502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number51603
License Number StateCA

VIII. Authorized Official

Name: DR. DIANA SWANSON
Title or Position: OWNER
Credential: DMD
Phone: 408-265-6501