=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578656104
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM P SWETLIK D.D.S., M.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 115 ALPINE CT
-----------------------------------------------------
City | SHAWANO
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-526-2544
-----------------------------------------------------
Fax | 715-526-2547
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 115 ALPINE CT
-----------------------------------------------------
City | SHAWANO
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-526-2544
-----------------------------------------------------
Fax | 715-526-2547
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 5001358-015
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------