Healthcare Provider Details

I. General information

NPI: 1104074897
Provider Name (Legal Business Name): SWANSON DENTAL CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2008
Last Update Date: 09/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 DUFF AVE
AMES IA
50010-5467
US

IV. Provider business mailing address

1212 DUFF AVE
AMES IA
50010-5467
US

V. Phone/Fax

Practice location:
  • Phone: 515-233-2174
  • Fax: 515-233-0351
Mailing address:
  • Phone: 515-233-2174
  • Fax: 515-233-0351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ROBERT SWANSON
Title or Position: PRESIDENT
Credential:
Phone: 515-233-2174