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General NPI Number Information
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NPI Number | 1508491564
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Entity Type | Individual
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Provider Name | JUSTIN SWANK DDS
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Gender | Male
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Dates
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Enumeration Date | 03/10/2020
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 262 BOSTON POST RD
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City | WATERFORD
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State | CT
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Zip | 06385-2053
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Country | US
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Telephone | 860-443-0861
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Fax |
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Provider Business Mailing Address
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Address Line | 262 BOSTON POST RD
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City | WATERFORD
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State | CT
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Zip | 06385-2053
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Country | US
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Telephone |
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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 | 14148
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License Number State | CT
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