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General NPI Number Information
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NPI Number | 1710567177
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Entity Type | Individual
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Provider Name | MERLE RAY SWARTZENTRUBER DMD
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Gender | Male
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Dates
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Enumeration Date | 04/10/2021
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Last Update Date | 08/18/2021
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Provider Practice Location Address
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Address Line | 6783 VETERANS PKWY BLDG 4
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City | COLUMBUS
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State | GA
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Zip | 31909-3254
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Country | US
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Telephone | 706-321-3909
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Fax |
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Provider Business Mailing Address
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Address Line | 3732 US HIGHWAY 431 N
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City | PHENIX CITY
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State | AL
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Zip | 36867-2362
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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 | D-0006952-C1
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN122465
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License Number State | GA
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