Provider Demographics
NPI:1093704884
Name:SWAIN, JULIAN JACKSON JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:JACKSON
Last Name:SWAIN
Suffix:JR
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 1:405 TYSON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-4821
Mailing Address - Country:US
Mailing Address - Phone:731-642-2244
Mailing Address - Fax:731-644-9532
Practice Address - Street 1:405 TYSON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4821
Practice Address - Country:US
Practice Address - Phone:731-642-2244
Practice Address - Fax:731-644-9532
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS47291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice