Healthcare Provider Details

I. General information

NPI: 1528299286
Provider Name (Legal Business Name): VALERIE L SWAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 S. MAIN ST.
NAPERVILLE IL
60540
US

IV. Provider business mailing address

405 S. MAIN ST.
NAPERVILLE IL
60540
US

V. Phone/Fax

Practice location:
  • Phone: 630-357-7273
  • Fax:
Mailing address:
  • Phone: 630-357-7273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number019.029999
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: