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General NPI Number Information
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NPI Number | 1336405315
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Entity Type | Individual
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Provider Name | MATTHEW ALLEN SWAN DDS
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Gender | Male
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Dates
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Enumeration Date | 04/04/2012
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3714 HEATH RD FL 32277
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City | JACKSONVILLE
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State | FL
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Zip | 32277-2045
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Country | US
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Telephone | 904-302-7552
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Fax |
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Provider Business Mailing Address
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Address Line | 1051 LAURISTON DRIVE
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City | ST. JOHNS
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State | FL
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Zip | 32259
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Country | US
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Telephone | 801-718-8348
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN22952
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License Number State | FL
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