Provider Demographics
NPI:1033270798
Name:SWENSON, KEVIN SHAWN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:SHAWN
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 1:552 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23847-1236
Mailing Address - Country:US
Mailing Address - Phone:434-634-0035
Mailing Address - Fax:
Practice Address - Street 1:552 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-1236
Practice Address - Country:US
Practice Address - Phone:434-634-0035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA8560122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist