Provider Demographics
NPI:1023010170
Name:SWARTS, RANDY MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:MARK
Last Name:SWARTS
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 1:3109 S CENTER ST
Mailing Address - Street 2:STE 102
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-4789
Mailing Address - Country:US
Mailing Address - Phone:641-752-3377
Mailing Address - Fax:641-753-3455
Practice Address - Street 1:3109 S CENTER ST
Practice Address - Street 2:STE 102
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-4789
Practice Address - Country:US
Practice Address - Phone:641-752-3377
Practice Address - Fax:641-753-3455
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA71021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0039511Medicaid