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General NPI Number Information
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NPI Number | 1497853105
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Entity Type | Individual
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Provider Name | JAMES RICHARD SWANSTROM DDS.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/05/2010
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Provider Practice Location Address
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Address Line | 601 HIGHWAY 73 SCENIC RIVERS DENTAL
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City | FLOODWOOD
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State | MN
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Zip | 55736
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Country | US
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Telephone | 218-476-2969
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Fax | 218-476-1599
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Provider Business Mailing Address
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Address Line | 5934 N. PIKE LAKE ROAD
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City | DULUTH
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State | MN
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Zip | 55811
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Country | US
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Telephone | 218-724-2947
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7924
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7924
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License Number State | MN
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