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General NPI Number Information
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NPI Number | 1629456603
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Entity Type | Individual
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Provider Name | PATRICIA SWANSON
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Gender | Female
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Dates
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Enumeration Date | 05/11/2015
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Last Update Date | 10/04/2019
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Provider Practice Location Address
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Address Line | STONY BROOK SCHOOL OF DENTAL MEDICINE DENTAL CARE CENTER, SULLIVAN HALL
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City | STONY BROOK
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State | NY
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Zip | 11794-8712
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Country | US
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Telephone | 631-632-3709
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Fax | 631-362-3961
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Provider Business Mailing Address
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Address Line | SULLIVAN HALL ROOM 170
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City | STONY BROOK
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State | NY
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Zip | 11794-8712
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Country | US
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Telephone | 631-632-8971
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Fax | 631-362-7658
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 060021
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License Number State | NY
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