MEDICARE: DR. JACK CLARK SWARTOUT II 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	1223G0001X	General Practice Dentistry	12012687A	IN

General Provider Information

NPI Number	:	1396274221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK CLARK SWARTOUT II DDS

Provider Business Mailing Address
First Line	:	1040 PATRICK PL STE B
Second Line	:
City	:	BROWNSBURG
State	:	IN
Zip	:	46112-2432
Country	:	US
Telephone Number	:	317-852-3176
Fax Number	:	317-852-3156

Provider Business Practice Location Address
First Line	:	1040 PATRICK PL STE B
Second Line	:
City	:	BROWNSBURG
State	:	IN
Zip	:	46112-2432
Country	:	US
Telephone Number	:	317-852-3176
Fax Number	:	317-852-3156

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

Provider Enumeration Date	:	06/05/2017
Last Update Date	:	01/19/2026

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