Provider Demographics
NPI:1033240742
Name:SWAN, TIMOTHY MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MICHAEL
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 1:2626 NORTH ARNOULT RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002
Mailing Address - Country:US
Mailing Address - Phone:504-324-4952
Mailing Address - Fax:504-265-0472
Practice Address - Street 1:2626 NORTH ARNOULT RD
Practice Address - Street 2:SUITE 110
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002
Practice Address - Country:US
Practice Address - Phone:504-324-4952
Practice Address - Fax:504-265-0472
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA48191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice