Provider Demographics
NPI:1033197660
Name:SWANSON, PEGGY ANN (RDH)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:ANN
Last Name:SWANSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60451 UMATILLA CIR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-8920
Mailing Address - Country:US
Mailing Address - Phone:541-382-2799
Mailing Address - Fax:541-389-2958
Practice Address - Street 1:124 NW HAWTHORNE AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-2918
Practice Address - Country:US
Practice Address - Phone:541-389-1301
Practice Address - Fax:541-389-2958
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH32891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice