Healthcare Provider Details

I. General information

NPI: 1992957534
Provider Name (Legal Business Name): TARA ELANN SWANTON D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4460 EAST COUNTY ROAD F-41
OSCODA MI
48750
US

IV. Provider business mailing address

4460 EAST COUNTY ROAD F-41
OSCODA MI
48750
US

V. Phone/Fax

Practice location:
  • Phone: 989-739-5255
  • Fax: 989-739-1662
Mailing address:
  • Phone: 989-739-5255
  • Fax: 989-739-1662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901017272
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: