MEDICARE: GREGORY SWICA D.D.S.

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	2108	MT

General Provider Information

NPI Number	:	1700097607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY SWICA D.D.S.

Provider Business Mailing Address
First Line	:	2901 BROOKS ST
Second Line	:	SAPPHIRE DENTAL GROUP
City	:	MISSOULA
State	:	MT
Zip	:	59801-7722
Country	:	US
Telephone Number	:	406-541-2886
Fax Number	:	406-541-2889

Provider Business Practice Location Address
First Line	:	2901 BROOKS ST
Second Line	:	SAPPHIRE DENTAL GROUP
City	:	MISSOULA
State	:	MT
Zip	:	59801-7722
Country	:	US
Telephone Number	:	406-541-2886
Fax Number	:	406-541-2889

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	04/27/2010

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