Provider Demographics
NPI:1033280086
Name:SWENSON, JON REID I (DDS)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:REID
Last Name:SWENSON
Suffix:I
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 1:2335 SW 320TH STR.
Mailing Address - Street 2:STE.2
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023
Mailing Address - Country:US
Mailing Address - Phone:253-838-9715
Mailing Address - Fax:253-838-7009
Practice Address - Street 1:2335 SW 320TH ST
Practice Address - Street 2:STE.2
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-2569
Practice Address - Country:US
Practice Address - Phone:253-838-9715
Practice Address - Fax:253-838-7009
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA51051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice