Provider Demographics
NPI:1144577792
Name:SWAINHART, SAMUEL REED (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:REED
Last Name:SWAINHART
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4056 E WEAVER RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-6884
Mailing Address - Country:US
Mailing Address - Phone:859-866-1504
Mailing Address - Fax:
Practice Address - Street 1:34597 N 60TH ST
Practice Address - Street 2:SUITE #103
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85266-5241
Practice Address - Country:US
Practice Address - Phone:480-488-7010
Practice Address - Fax:480-488-7008
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD009223122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist