Provider Demographics
NPI:1013179076
Name:SWAN, STEVEN ARTHUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ARTHUR
Last Name:SWAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 BROOKHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-5491
Mailing Address - Country:US
Mailing Address - Phone:337-280-8224
Mailing Address - Fax:
Practice Address - Street 1:715 N LEWIS ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2045
Practice Address - Country:US
Practice Address - Phone:337-256-8658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA58901223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1893170Medicaid