Healthcare Provider Details

I. General information

NPI: 1912969114
Provider Name (Legal Business Name): ERIC L. SWENSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

378 E 400 S SUITE 1
SPRINGVILLE UT
84663-1980
US

IV. Provider business mailing address

378 E 400 S SUITE 1
SPRINGVILLE UT
84663-1980
US

V. Phone/Fax

Practice location:
  • Phone: 801-489-9456
  • Fax:
Mailing address:
  • Phone: 801-489-9456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7908107-9922
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: