Healthcare Provider Details

I. General information

NPI: 1922165240
Provider Name (Legal Business Name): ROBERT C SWEEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6176 NORTH GOVERNMENT WAY
COEUR D ALENE ID
83815
US

IV. Provider business mailing address

8509 N MAPLE ST
HAYDEN ID
83835
US

V. Phone/Fax

Practice location:
  • Phone: 208-762-3027
  • Fax: 208-762-0531
Mailing address:
  • Phone: 208-762-0957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD3793
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: