MEDICARE: DR. MATTHEW ALLEN SWAN DDS

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	1223P0221X	Pediatric Dentistry	DN22952	FL

General Provider Information

NPI Number	:	1336405315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW ALLEN SWAN DDS

Provider Business Mailing Address
First Line	:	1051 LAURISTON DRIVE
Second Line	:
City	:	ST. JOHNS
State	:	FL
Zip	:	32259
Country	:	US
Telephone Number	:	801-718-8348
Fax Number	:

Provider Business Practice Location Address
First Line	:	3714 HEATH RD FL 32277
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32277-2045
Country	:	US
Telephone Number	:	904-302-7552
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2012
Last Update Date	:	07/21/2022

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