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General NPI Number Information
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NPI Number | 1063684462
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Entity Type | Organization
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Legal Business Name | RILEY R SWANSON DDS, PC
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Dates
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Enumeration Date | 03/26/2008
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 2090 GODBY RD
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City | COLLEGE PARK
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State | GA
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Zip | 30349-5248
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Country | US
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Telephone | 770-991-0212
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Fax | 770-997-4854
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Provider Business Mailing Address
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Address Line | 2090 GODBY RD
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City | COLLEGE PARK
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State | GA
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Zip | 30349-5248
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Country | US
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Telephone | 770-991-0212
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Fax | 770-997-4854
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RILEY R SWANSON SR.
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Credential | DDS
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Telephone | 770-991-0212
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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 | 9207
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License Number State | GA
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