Healthcare Provider Details

I. General information

NPI: 1780776781
Provider Name (Legal Business Name): ERIC D SWANSON M.D.,D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 E FLAMINGO RD 288
LAS VEGAS NV
89119-0818
US

IV. Provider business mailing address

2030 E FLAMINGO RD 288
LAS VEGAS NV
89119-0818
US

V. Phone/Fax

Practice location:
  • Phone: 702-892-0833
  • Fax: 702-892-0906
Mailing address:
  • Phone: 702-892-0833
  • Fax: 702-892-0906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number9150
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number9150
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: