=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750213187
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOTT DAVID SCHWANDT DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2026
-----------------------------------------------------
Last Update Date | 06/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 707 US HIGHWAY 24 N
-----------------------------------------------------
City | BUENA VISTA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81211-9863
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-395-8610
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 765 HAMPDEN AVE APT 607
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55114-1674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-388-6302
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DEN.00206632
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------