Healthcare Provider Details

I. General information

NPI: 1588733703
Provider Name (Legal Business Name): MUNSTER ORAL SURGERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 COLUMBIA AVENUE SUITE D 1
MUNSTER IN
46321
US

IV. Provider business mailing address

9250 COLUMBIA AVENUE SUITE D 1
MUNSTER IN
46321
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-1500
  • Fax:
Mailing address:
  • Phone: 219-836-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: DR. RODNEY P SWANTKO
Title or Position: PRESIDENT
Credential: DDS
Phone: 219-836-1500