Healthcare Provider Details

I. General information

NPI: 1255304507
Provider Name (Legal Business Name): JAMES Q SWIFT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 DELAWARE ST SE 7-174 MOOS TOWER
MINNEAPOLIS MN
55455
US

IV. Provider business mailing address

2854 HIGHWAY 55 SUITE 130
EAGAN MN
55121
US

V. Phone/Fax

Practice location:
  • Phone: 612-624-4435
  • Fax: 612-624-2669
Mailing address:
  • Phone: 651-842-3344
  • Fax: 651-842-3391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number10436
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: