MEDICARE: RIVERTOWNE FAMILY DENTISTRY

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	4694	SC

General Provider Information

NPI Number	:	1215227020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERTOWNE FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	1551 BEN SAWYER BLVD UNIT 23
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-5509
Country	:	US
Telephone Number	:	843-518-3701
Fax Number	:

Provider Business Practice Location Address
First Line	:	2023 HIGHWAY 41
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-6200
Country	:	US
Telephone Number	:	843-518-3701
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	DR. MATHEW JAMES SWENSON
Credential	:	DDS
Telephone Number	:	843-518-3701

Provider Enumeration Date	:	04/13/2011
Last Update Date	:	04/13/2011

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Directions to “RIVERTOWNE FAMILY DENTISTRY ” Practice Location

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