Provider Demographics
NPI:1033200118
Name:SWANTEK, JASON JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:JOSEPH
Last Name:SWANTEK
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 1:1602 N RANDALL AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-1124
Mailing Address - Country:US
Mailing Address - Phone:608-756-8744
Mailing Address - Fax:
Practice Address - Street 1:1602 N RANDALL AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-1124
Practice Address - Country:US
Practice Address - Phone:608-756-8744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6797-15122300000X
IL19026988122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist