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General NPI Number Information
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NPI Number | 1013140706
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Entity Type | Individual
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Provider Name | RYAN DALE SWISS DDS
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Gender | Male
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Dates
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Enumeration Date | 08/27/2009
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Last Update Date | 06/09/2023
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Provider Practice Location Address
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Address Line | 320 W HOSPITAL RD
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City | FORT GORDON
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State | GA
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Zip | 30905-5741
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Country | US
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Telephone | 706-787-8105
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Fax |
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Provider Business Mailing Address
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Address Line | 1142 BRIGHTON DR
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City | EVANS
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State | GA
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Zip | 30809-8265
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Country | US
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Telephone | 714-904-9136
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7750
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D07750
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 10470
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License Number State | SC
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