Healthcare Provider Details

I. General information

NPI: 1760702906
Provider Name (Legal Business Name): JEFFREY AARON SWIHART D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21813 STATE ROAD 120
ELKHART IN
46516
US

IV. Provider business mailing address

21813 STATE ROAD 120
ELKHART IN
46516
US

V. Phone/Fax

Practice location:
  • Phone: 574-848-7487
  • Fax: 219-548-8848
Mailing address:
  • Phone: 574-848-7487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12011431A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: