Provider Demographics
NPI:1164618344
Name:SWAN, KATHRYN ANNE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:ANNE
Last Name:SWAN
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Gender:F
Credentials:DDS, MS
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Mailing Address - Street 1:6677 CROSSINGS DR SE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-7889
Mailing Address - Country:US
Mailing Address - Phone:616-698-2323
Mailing Address - Fax:616-871-9253
Practice Address - Street 1:6677 CROSSINGS DR SE
Practice Address - Street 2:SUITE 2
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-7889
Practice Address - Country:US
Practice Address - Phone:616-698-2323
Practice Address - Fax:616-871-9253
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2009-06-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI29010190441223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics