MEDICARE: DR. PHILLIP CLARK SWANTEK 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	2901022807	MI

General Provider Information

NPI Number	:	1871073619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP CLARK SWANTEK D.D.S.

Provider Business Mailing Address
First Line	:	2850 US 41 W
Second Line	:
City	:	MARQUETTE
State	:	MI
Zip	:	49855-2253
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2850 US 41 W
Second Line	:
City	:	MARQUETTE
State	:	MI
Zip	:	49855-2253
Country	:	US
Telephone Number	:	906-629-1369
Fax Number	:	906-225-1708

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

Provider Enumeration Date	:	08/21/2018
Last Update Date	:	08/21/2018

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