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General NPI Number Information
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NPI Number | 1710142567
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Entity Type | Individual
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Provider Name | LISA SUSAN SWANSON D.D.S
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Gender | Female
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Dates
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Enumeration Date | 07/22/2008
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Last Update Date | 10/18/2016
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Provider Practice Location Address
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Address Line | 54 WESTERVIEW DR
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City | WESTERVILLE
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State | OH
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Zip | 43081-2682
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Country | US
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Telephone | 614-794-3629
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Fax | 614-794-3672
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Provider Business Mailing Address
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Address Line | 355 W MAIN ST
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City | LEXINGTON
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State | OH
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Zip | 44904-9543
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Country | US
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Telephone | 419-884-3411
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Fax | 419-884-0656
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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 | 22855
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License Number State | OH
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