Healthcare Provider Details

I. General information

NPI: 1134199003
Provider Name (Legal Business Name): GARY DANIEL SWIEC DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W BALTIMORE ST
BALTIMORE MD
21201
US

IV. Provider business mailing address

6208 WAVING WILLOW PATH
CLARKSVILLE MD
21029-2101
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-7101
  • Fax:
Mailing address:
  • Phone: 706-231-6974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number9520
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9520
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: