Healthcare Provider Details

I. General information

NPI: 1356320576
Provider Name (Legal Business Name): DAVID C SWIDERSKI DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 04/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 LIBERTY ST SE
SALEM OR
97302-4345
US

IV. Provider business mailing address

1565 LIBERTY ST SE
SALEM OR
97302-4345
US

V. Phone/Fax

Practice location:
  • Phone: 503-581-0223
  • Fax:
Mailing address:
  • Phone: 503-581-0223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number11819
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number50992
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD9087
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberMD29162
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: