Provider Demographics
NPI:1033222047
Name:SWENSON, MATHEW JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATHEW
Middle Name:JAMES
Last Name:SWENSON
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 1:1551 BEN SAWYER BLVD UNIT 23
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-5509
Mailing Address - Country:US
Mailing Address - Phone:843-518-3701
Mailing Address - Fax:
Practice Address - Street 1:2023 HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-6200
Practice Address - Country:US
Practice Address - Phone:843-518-3701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC46941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice