MEDICARE: BARBARA D. SWANKHOUSE DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	10476	CO

General Provider Information

NPI Number	:	1083026926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARBARA D. SWANKHOUSE DDS PC

Provider Business Mailing Address
First Line	:	363 S HARLAN ST STE 110
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-3552
Country	:	US
Telephone Number	:	303-935-6559
Fax Number	:	303-935-5408

Provider Business Practice Location Address
First Line	:	363 S HARLAN ST STE 110
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-3552
Country	:	US
Telephone Number	:	303-935-6559
Fax Number	:	303-935-5408

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. BARBARA DEANNA SWANKHOUSE
Credential	:	DDS
Telephone Number	:	303-935-6559

Provider Enumeration Date	:	05/27/2014
Last Update Date	:	05/27/2014

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